Evaluation of pituitary incidentaloma

How should a pituitary adenoma, including a pituitary incidentaloma, initially be evaluated?

  • A thorough history and physical examination can detect symptoms and/or signs of pituitary hormone excess or hypopituitarism.
  • Baseline pituitary hormone testing should include the following serum/plasma measurements: an a.m. cortisol, ACTH, prolactin (PRL), GH, insulin-like growth factor 1 (IGF-1), TSH, free thyroxine (free T ), LH, FSH, testosterone (men), and estradiol (women).
  • A dehydroepiandrosterone sulfate (DHEA-S) level is also helpful in assessing for possible central adrenal insufficiency because it is the earliest adrenal marker of deficiency.
  • Additional screening tests for Cushing’s disease are recommended only if clinically indicated.
  • In assessing for preoperative hypopituitarism, emphasis should be placed on diagnosing and replacing thyroid hormone and glucocorticoid deficiencies, as needed.

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