A survey of surgically resected pituitary incidentalomas and a comparison of the clinical features and surgical outcomes of non-functioning pituitary adenomas discovered incidentally versus symptomatically

Abstract

Abstract Background Clinically nonfunctioning pituitary adenomas(CNFPAs) constitute one of the most common tumors in the sellar region and are often discovered only when associated with compressive symptoms. With the frequent use of brain imaging, there has been an increase in the prevalence of incidentally discovered CNFPAs. Aim We aim to determine the prevalence of incidental diagnosis with CNPAs observed over a decade and compare the analytical, clinical and treatment differences between those who were diagnosed either incidentally or symptomatically. We also intend to evaluate the pathology differences between both groups. Methods We retrospectively analyzed patients aged ≥ 18years with an apparent CNFPA.defined as a pituitary lesion compatible with pituitary adenoma which is not associated with the clinical or biochemical evidence of a hormone-secreting tumor. Inclusion criteria included normal prolactin level for lesions < 9mm or a prolactin level < 100ng/mL for lesions ≥ 10mm in maximal tumor diameter. Results We included 119patients [53.8% males; mean age:56.8 years(SD = 16.7)]. Diagnosis was incidental in 47.1% of patients and many patients had unappreciated signs and symptoms of pituitary disease. In the symptomatic and incidental groups,66.7% and41.1% of patients had hypopituitarism, respectively(p = 0.005). Only20.4% of patients incidentally diagnosed had microadenoma(p = 0.060). Hypopituitarism was present in18.8% of those patients with microadenomas. Most tumors were macroadenomas(87.4%). Half of those patients diagnosed incidentally were submitted to surgery, compared to75.8% of those who were diagnosed symptomatically(p = 0.004). Conclusions CNFPAs are commonly diagnosed incidentally, with many manifesting symptoms on examination. Accordingly, if there was a greater level of knowledge and more suspicion about these pathologies, it might be possible to discover them earlier.