How should a pituitary nonfunctioning adenoma including a pituitary incidentaloma be followed?
For NFA/microadenomas, follow-up MRI imaging is recommended at 1-, 2-, and 5-year intervals. Pituitary hormone reevaluation should be considered if there has been significant interval tumor growth, or as clinically indicated. TSS is recommended for any significant interval tumor growth associated with vision defects, loss of pituitary gland function, intractable headaches, or evidence of hormone overproduction. For stable tumor size over a 5-year period, particularly with tumors < 5 mm, consideration can be given to foregoing additional imaging.
NFA/macroadenomas that are not treated surgically require closer MRI follow-up because of the risk of tumor growth. Specifically, follow-up MRI imaging at 6 months and then annually for 5 years is recommended. Transsphenoidal resection is recommend for any significant interval tumor growth associated with vision defects, loss of pituitary gland function, intractable headaches, or evidence of hormone overproduction (in cases of previous “silent” tumors). For asymptomatic tumors over a prolonged period, decreased imaging frequency (every 2–5 years) can be considered.