The 'Incidentaloma' of the Pituitary Gland
We describe a series of 18 patients with an intrasellar mass incidentally discovered by computed tomography or magnetic resonance imaging. The average size of the mass was 13 mm, with a range from 5 to 25 mm. Initial ophthalmologic examination revealed bitemporal hemianopia in 2 patients. Results of routine endocrine testing showed partial hypopituitarism in 5 patients and growth hormone hypersecretion without signs and symptoms of acromegaly in 1 patient. Four patients underwent neurosurgery. Histologically, one chondroid chordoma and three pituitary adenomas were found. In the remaining 14 patients treated conservatively, repeated computed tomography and magnetic resonance imaging revealed no significant change in tumor size at the time of follow up (median, 22 months) Our results suggest that the "incidentaloma" of the pituitary gland is a benign condition that does not necessarily require neurosurgical intervention. (JAMA. 1990;263:2772 2776) IN 1936, Costello1 reported in his inves! tigation entitled "Subclinical Adenomas of the Pituitary Gland" that in a series of 1000 pituitary glands obtained from unselected autopsies pituitary adenomas occurred with the remarkable frequen! cy of 22.5% The tumors were unassociated with clinical signs or obvious hor! monal abnormalities and remained undiagnosed during the subjects' life!