Treatment of Incidentalomas and nonfunctioning pituitary tumors

What are the treatment indications and options for incidentalomas and nonfunctioning pituitary tumors?

With the exception of prolactinomas, functional pituitary adenomas, including incidentalomas, should be managed first line with transsphenoidal surgery (TSS). In addition, TSS is first-line therapy for nonfunctioning adenomas with the following indications:

• Symptoms of visual field deficits, vision loss or ophthalmoplegia

• Compression of the optic apparatus on MRI

• Endocrine dysfunction, including hypopituitarism or stalk effect causing hyperprolactinemia

• Pituitary apoplexy

• Refractory headaches not attributable to other headache syndromes or etiologies

• Other neurologic deficits related to compression from the tumor

Importantly, TSS should be performed by an experienced neurosurgeon who routinely performs either microscopic or endoscopic transsphenoidal techniques, and ideally as part of an expert pituitary-dedicated team (e.g., endocrinologists, neuropathologists, radiation oncologists). Lastly, radiation therapy is usually second-line therapy for a NFA if surgery is contraindicated or not desired.


Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information