Evaluation and management of pituitary incidentalomas

A surprising number of apparently healthy people harbor unsuspected pituitary tumors, which are being discovered incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) performed for other reasons. The majority can be safely observed; for others, medical therapy or surgical resection is necessary. In this article we outline our approach. KEY POINTS Two key questions that must be answered when a pituitary incidentaloma is discovered are whether it is hormonally active and whether it is causing a mass effect (eg, a visual field defect due to pressure on the optic chiasm). Incidentalomas that are not hormonally active and that are not causing a mass effect can generally be managed by watchful waiting. Hormonally active prolactin-secreting tumors can be treated with dopamine agonists. Other hormonally active tumors and those that are causing a mass effect should be surgically removed. The risks of further tumor growth and of pituitary apoplexy are higher in tumors that are larger when discovered.