Syed Ali Imran1, Churn-Ern Yip2, Netee Papneja3, Khaled Aldahmani4, Syed Mohammad2, Fatima Imran2, Deborah A Zwicker5, Chris Theriault2, Kara Thompson2, David B Clarke6, Stan Van Uum3. 1. Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada simran@dal.ca. 2. Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada. 3. Division of Endocrinology and MetabolismWestern University, London, Ontario, Canada. 4. Department of MedicineTawam Hospital in affiliation with Johns Hopkins, Al Ain, UAE. 5. Cape Breton Regional HospitalSydney, Nova Scotia, Canada. 6. Division of NeurosurgeryDalhousie University, Halifax, Nova Scotia, Canada.
Abstract
OBJECTIVES: Pituitary incidentalomas (PI) are frequently found on brain imaging. Despite their high prevalence, little is known about their long-term natural history and there are limited guidelines on how to monitor them. METHODS: We conducted a retrospective study to compare epidemiological characteristics at presentation and the natural history of PI in population-based vs referral-based registries from two tertiary-care referral centers in Canada. RESULTS: A total of 328 patients with PI were included, of whom 73% had pituitary adenomas (PA) and 27% had non-pituitary sellar masses. The commonest indications for imaging were headache (28%), dizziness (12%) and stroke/transient ischemic attack (TIA) (9%). There was a slight female preponderance (52%) with a median age of 55 years at diagnosis; 71% presented as macroadenomas (>10mm). Of PA, 25% were functioning tumors and at presentation 36% of patients had evidence of secondary hormonal deficiency (SHD). Of the total cohort, 68% were treated medically or conservatively whereas 32% required surgery. Most tumors (87% in non-surgery and 68% in post-surgery group) remained stable during follow-up. Similarly, 84% of patients in the non-surgery and 73% in the surgery group did not develop additional SHD during follow-up. The diagnosis of non-functioning adenoma was a risk factor for tumor enlargement and a change in SHD status was associated with a change in tumor size. CONCLUSIONS: Our data suggest that most PI seen in tertiary-care referral centers present as macroadenomas and may frequently be functional, often requiring medical or surgical intervention.
OBJECTIVES:Pituitary incidentalomas (PI) are frequently found on brain imaging. Despite their high prevalence, little is known about their long-term natural history and there are limited guidelines on how to monitor them. METHODS: We conducted a retrospective study to compare epidemiological characteristics at presentation and the natural history of PI in population-based vs referral-based registries from two tertiary-care referral centers in Canada. RESULTS: A total of 328 patients with PI were included, of whom 73% had pituitary adenomas (PA) and 27% had non-pituitary sellar masses. The commonest indications for imaging were headache (28%), dizziness (12%) and stroke/transient ischemic attack (TIA) (9%). There was a slight female preponderance (52%) with a median age of 55 years at diagnosis; 71% presented as macroadenomas (>10mm). Of PA, 25% were functioning tumors and at presentation 36% of patients had evidence of secondary hormonal deficiency (SHD). Of the total cohort, 68% were treated medically or conservatively whereas 32% required surgery. Most tumors (87% in non-surgery and 68% in post-surgery group) remained stable during follow-up. Similarly, 84% of patients in the non-surgery and 73% in the surgery group did not develop additional SHD during follow-up. The diagnosis of non-functioning adenoma was a risk factor for tumor enlargement and a change in SHD status was associated with a change in tumor size. CONCLUSIONS: Our data suggest that most PI seen in tertiary-care referral centers present as macroadenomas and may frequently be functional, often requiring medical or surgical intervention.
Authors: Khaled Al Dahmani; Bachar Afandi; Ali Elhouni; Denish Dinwal; Jim Philip; Alaaeldin Bashier; Salem A Beshyah; Nico Nagelkerke; Juma M Alkaabi Journal: Oman Med J Date: 2020-09-20
Authors: Abbas Ali Mansour; Ali Hussain Ali Alhamza; Ammar Mohammed Saeed Abdullah Almomin; Ibrahim Abbood Zaboon; Nassar Taha Yaseen Alibrahim; Rudha Naser Hussein; Muayad Baheer Kadhim; Haider Ayad Yassin Alidrisi; Hussein Ali Nwayyir; Adel Gassab Mohammed; Dheyaa Kadhim Al-Waeli; Ibrahim Hani Hussein Journal: F1000Res Date: 2018-04-06
Authors: Nadine M Vaninetti; David B Clarke; Deborah A Zwicker; Churn-Ern Yip; Barna Tugwell; Steve Doucette; Chris Theriault; Khaled Aldahmani; Syed Ali Imran Journal: Endocr Connect Date: 2018-04-30 Impact factor: 3.335
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