New Clinical Practice Guideline for evaluation and treatment of pituitary incidentalomas

New clinical practice guideline recommends that patients with a pituitary incidentaloma undergo complete history and physical examination

Today, The Endocrine Society released a new Clinical Practice Guideline (CPG) for the evaluation and treatment of pituitary incidentalomas. The CPG is published in the April 2011 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.

A pituitary incidentaloma is a tumor or lesion on or near the pituitary gland. It is found when a person has an imaging test for an unrelated reason. Doctors call this an "incidental" finding, meaning by chance-thus, the name incidentaloma. This surprise finding is not uncommon. In studies of adults who had head imaging with MRI or CT scans for reasons other than pituitary disease, small incidentalomas were present in up to 20 percent of patients.

"Fortunately, incidentalomas are almost always benign and usually do not need surgery," said Pamela Freda, MD, of the Columbia College of Physicians & Surgeons in New York and chair of the task force that authored the CPG. "This new Clinical Practice Guideline makes recommendations for evaluating and treating a patient with a pituitary incidentaloma, and indicating when surgical therapy may be necessary."

Recommendations from the CPG include:

• A complete history and physical examination, including a visual field examination if the lesion is touching the optic nerves, for patients with a pituitary incidentaloma;
• Clinical assessments, neuro-imaging and visual field examinations for patients with pituitary incidentalomas not meeting criteria for surgical removal; and
• Surgery for patients with pituitary incidentaloma if the tumor is leading to visual abnormalities, stroke-like damage to the pituitary gland (also known as a pituitary apoplexy) or if the tumor itself is producing excess hormones other than prolactin.

The Hormone Foundation, the patient education affiliate of The Endocrine Society, has published a companion patient guide to this CPG. The patient guide, which can be found online at www.hormone.org/Resources/upload/Pituitary-Incidentaloma-Web.pdf, defines the different types of pituitary incidentalomas, lists the condition's symptoms and explains how incidentalomas are treated and when surgery may be needed.

Other members of The Endocrine Society task force that developed this CPG include: Albert Beckers of CHU de Li-ge in Belgium; Laurence Katznelson of Stanford University in Calif.; Mark Molitch of the Northwestern Feinberg School of Medicine in Chicago, Ill.; Victor Montori of Mayo Clinic Rochester in Minn.; Kalmon Post of Mount Sinai Medical Center in New York, N.Y.; and Mary Lee Vance of the University of Virginia Health Science Center in Charlottesville.

The Society established the Clinical Practice Guideline (CPG) Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis and treatment of endocrine-related conditions. Each CPG is created by a task force of topic-related experts in the field. Task forces rely on scientific reviews of the literature in the development of CPG recommendations. The Endocrine Society does not solicit or accept corporate support for its CPGs. All CPGs are supported entirely by Society funds.