pituitary incidentaloma Rx - gainer84

[ArchivalUser]

Is there a specific SIZE of pituitary incidentaloma, when the treatment is SURGERY even if it is nonfunctional????

(I had read in cases of Adrenal incidentaloma, surgery shud be done if size>6 cm, and b/w 4-6cm--- pts can be given a choice if they want to go fr surgery or not)...So, is there any guidelines fr SURGERY like this fr pituitary incidentaloma??????

[ArchivalUser]

MICROINCIDENTALOMA: LESS THAN 1CM IN SIZE
MACROINCIDENTALOMA: ATLEAST 1 CM IN SIZE

FOR CLINICALLY HYPERFUNCTIONING:

1. IF PROLACTINOMA- DO SURGERY
2. OTHERS- SURGERY/MEDICAL THERAPY


CLINICALLY NON- FUNCTIONING, THEN:
1. MICRO-INCIDENTILOMA- REPEAT MRI 12 MTHS AFTER THE INITIAL ONE

2. MACRO-INCIDENTILOMA: VISUAL FIELD TESTING & FOR HYPOPITUTARISM.

3, IF STEP 2 IS ABNORMAL, THEN SURGERY

4. IF STEP 2 IS NORMAL, REPEAT MRI, PITUTARY FUNCTION & VISUAL FIELD TESTING AFTER 6 MTHS

[ArchivalUser]

prolactinoma,,always try medical as it decreases the size always from medical therapy
if any other functioning,,surgery

[ArchivalUser]

chapper, prolactinomas must never be treated with surgery as a first step ( even with visual issues in macroprolactinomas)

These are the guidelines to approach pituitary incidentalomas
( reference dr.red endocrinology)

1) In deciding how to approach INCIDENTALLY discovered pituitary tumors, first rule out Function ( i.e; hormone production).

2) To R/O functioning adenomas first - do prolactin level, Dexamethasone suppression test, ACTH level, TSH and IGF 1 level depending on the clinical features.

3) Functioning adenomas : Except Prolactinomas, all other functioning adenomas are treated primarily by surgery ( i.e; for secondary hyperthyroidism, acromegaly etc).

4) NON-FUNCTIONING ADENOMAS: If Non functioning adenomas, Surgery is indicated only if mass effects such as Visual field defects , Headaches and Hypopituitarism are present.
If non functioing adenomas are small and asymptomatic --> Follow patients with non functioning microadenomas and small, noninvasive macroadenomas with a 6-month MRI scan and yearly thereafter. If there is no evidence of enlargement after 3 to 5 years, then continue to follow patients clinically .

5) If prolactinomas,
a) Microademomas --> prolactin levels usually > 100
b) Macroadenomas --> Prolactin levels usually very high 500 to 1000. Be aware of HOOK Effect.
c) If high prolactin level encountered on blood tests and cannot be explained by meds/ stress. MRI is the next test. Be aware MRIs do not r/o small microadenomas ( use Bromocriptine ( dopamine agonist) as first line therapy. Surgery done only for those patients not responding to or intolerant of dopamine agonists.
e) If Prolactin Producing Macroadenomas are associated with mass effect --> Still bromocriptine must be tried first. Only if no response, Surgery ( trans sphenoidal resection) is done.
Understand that prolactinomas even when large and causing symptoms , they can shrink with dopamine agonists. Remember that Surgery done for pituitary adenomas is associated with long lasting serious consequences so, whenever possible, medical therapy must be used first line if response can be observed. That is why even in large symptomatic prolactinomas, dopamine agonists are the first step.

[ArchivalUser]

agree with prolactnomas but wote abt non-functioning micro incidentelomas