title: Analysis and natural history of pituitary incidentalomas.
abstract: OBJECTIVE
  Pituitary incidentalomas (PI) are frequently found on brain imaging. Despite their high prevalence, little is known about their long-term natural history and there are limited guidelines on how to monitor them.
  
  
  METHODS
  We conducted a retrospective study to compare epidemiological characteristics at presentation and the natural history of PI in population-based vs referral-based registries from two tertiary-care referral centers in Canada.
  
  
  RESULTS
  A total of 328 patients with PI were included, of whom 73% had pituitary adenomas (PA) and 27% had non-pituitary sellar masses. The commonest indications for imaging were headache (28%), dizziness (12%) and stroke/transient ischemic attack (TIA) (9%). There was a slight female preponderance (52%) with a median age of 55 years at diagnosis; 71% presented as macroadenomas (>10mm). Of PA, 25% were functioning tumors and at presentation 36% of patients had evidence of secondary hormonal deficiency (SHD). Of the total cohort, 68% were treated medically or conservatively whereas 32% required surgery. Most tumors (87% in non-surgery and 68% in post-surgery group) remained stable during follow-up. Similarly, 84% of patients in the non-surgery and 73% in the surgery group did not develop additional SHD during follow-up. The diagnosis of non-functioning adenoma was a risk factor for tumor enlargement and a change in SHD status was associated with a change in tumor size.
  
  
  CONCLUSIONS
  Our data suggest that most PI seen in tertiary-care referral centers present as macroadenomas and may frequently be functional, often requiring medical or surgical intervention.
authors.affiliation: Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada simran@dal.ca.
authors.forename: Syed Ali
authors.initials: SA
authors.lastname: Imran
authors.affiliation: Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Churn-Ern
authors.initials: CE
authors.lastname: Yip
authors.affiliation: Division of Endocrinology and MetabolismWestern University, London, Ontario, Canada.
authors.forename: Netee
authors.initials: N
authors.lastname: Papneja
authors.affiliation: Department of MedicineTawam Hospital in affiliation with Johns Hopkins, Al Ain, UAE.
authors.forename: Khaled
authors.initials: K
authors.lastname: Aldahmani
authors.affiliation: Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Syed
authors.initials: S
authors.lastname: Mohammad
authors.affiliation: Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Fatima
authors.initials: F
authors.lastname: Imran
authors.affiliation: Cape Breton Regional HospitalSydney, Nova Scotia, Canada.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Zwicker
authors.affiliation: Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Theriault
authors.affiliation: Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Kara
authors.initials: K
authors.lastname: Thompson
authors.affiliation: Division of NeurosurgeryDalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: David B
authors.initials: DB
authors.lastname: Clarke
authors.affiliation: Division of Endocrinology and MetabolismWestern University, London, Ontario, Canada.
authors.forename: Stan
authors.initials: S
authors.lastname: Van Uum
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome