Endocrine Abstracts

Introduction: Incidental pituitary adenoma (IPA) is found in 10–20% autopsy and radiological series. These are being increasingly detected as access to sensitive imaging modalities improves.

Methods: Patients with incidental pituitary findings between 2012 and 2016 were identified from local database. Referral details, clinical features and radiological findings were analysed. A single radiologist reviewed all images to avoid bias.

Results: Sixty-five patients referred to MDT during the study period. Thirteen (20%) were excluded as there was no discernible lesion on review.

Fifty-two patients were selected for analysis, 25 female. Mean age was 57 (20–92). Bulk of referral came from neurology (19; 37%), followed by other local hospitals (7; 14%) and GP (6; 12%).

Forty-three were macroadenoma (83%), mean size 21 mm (10–45 mm range). Forty had suprasellar extension, of which 10 caused compression/stretching of the chiasm. Of these, four had abnormal field. Fifteen had cavernous sinus extension laterally, 6 of them encircling the carotids. Seven were seen extending inferiorly. Only one had evidence of blood product on MRI.

Majority are being followed up radiologically. Eleven (21%) were offered surgery, either due to functioning tumour or mass effect from large tumour. Nine proceeded. One delayed due to cancer diagnosis. One declined. Histology were prolactinoma, acromegaly, mixed GH and ACTH and cortiocotrophinoma, craniopharyngioma and four gonadotrophinoma.

Conclusion: IPA is an increasingly recognised clinical entity. Our series highlight several important aspects. Firstly, 20% did not have a tumour and therefore the role of a dedicated pituitary neuroradiologist in avoiding unnecessary anxiety for patients cannot be overstated. Secondly, the large majority (85%) were macroadenoma and have the potential to cause clinical concern during the course. A significant proportion (20%) required surgery. Moreover, these could be functioning tumours. All these make a formal assessment of all IPAs in a dedicated pituitary MDT setting vital.