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Management of Incidental Pituitary Lesions
Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • CT/MR Imaging Reporting

      • Clinical Implications

        TERMINOLOGY

        • Definitions

          • Incidental pituitary lesions are those that are < 10 mm
            • Found on imaging studies not performed for pituitary evaluation
          • Most common incidental pituitary lesions include benign cysts and nonfunctioning pituitary adenomas
          • Lesions of pituitary gland > 10 mm require endocrine &/or neurosurgical evaluation
        • ACR recommendations 2018

          • Managing pituitary lesions incidentally detected on CT, MR, or FDG PET
          • Recommendations based on published evidence and expert opinion
          • Algorithm categorizes lesions on basis of imaging findings and clinical features
        • Endocrine Society published guidelines on following incidental pituitary lesions in 2011

          • Pituitary lesions of any size require clinical evaluation with laboratory evaluation, screening for hormone hypersecretion, and hypopituitarism
          • Normal pituitary function patients pituitary MR recommended
            • At 6 months for lesions > 10 mm
            • At 1 year for lesions ≤ 10 mm and progressively less frequently if lesion stable

        IMAGING ANATOMY

        • General Anatomic Considerations

          • Critical Anatomic Structures

            • Anatomic Relationships

              • Imaging Protocol Optimization

                • Classic Imaging Appearance

                  CLINICAL IMPLICATIONS

                  • Clinical Importance

                    • Management of Lesions Detected on MR and CT

                      • Management of Lesions Detected on FDG PET

                        Selected References

                        1. Chapman PR et al: Neuroimaging of the pituitary gland: practical anatomy and pathology. Radiol Clin North Am. 58(6):1115-33, 2020
                        2. Barkhoudarian G et al: Pituitary apoplexy. Neurosurg Clin N Am. 30(4):457-63, 2019
                        3. Mahdi ES et al: Prevalence of pituitary cysts in children using modern magnetic resonance imaging techniques. Pediatr Radiol. 49(13):1781-7, 2019
                        4. Hoang JK et al: Management of incidental pituitary findings on CT, MRI, and 18F-Fluorodeoxyglucose PET: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 15(7):966-72, 2018
                        5. Inoshita N et al: The 2017 WHO classification of pituitary adenoma: overview and comments. Brain Tumor Pathol. 35(2):51-6, 2018
                        Related Anatomy
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                        Related Differential Diagnoses
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • CT/MR Imaging Reporting

                            • Clinical Implications

                              TERMINOLOGY

                              • Definitions

                                • Incidental pituitary lesions are those that are < 10 mm
                                  • Found on imaging studies not performed for pituitary evaluation
                                • Most common incidental pituitary lesions include benign cysts and nonfunctioning pituitary adenomas
                                • Lesions of pituitary gland > 10 mm require endocrine &/or neurosurgical evaluation
                              • ACR recommendations 2018

                                • Managing pituitary lesions incidentally detected on CT, MR, or FDG PET
                                • Recommendations based on published evidence and expert opinion
                                • Algorithm categorizes lesions on basis of imaging findings and clinical features
                              • Endocrine Society published guidelines on following incidental pituitary lesions in 2011

                                • Pituitary lesions of any size require clinical evaluation with laboratory evaluation, screening for hormone hypersecretion, and hypopituitarism
                                • Normal pituitary function patients pituitary MR recommended
                                  • At 6 months for lesions > 10 mm
                                  • At 1 year for lesions ≤ 10 mm and progressively less frequently if lesion stable

                              IMAGING ANATOMY

                              • General Anatomic Considerations

                                • Critical Anatomic Structures

                                  • Anatomic Relationships

                                    • Imaging Protocol Optimization

                                      • Classic Imaging Appearance

                                        CLINICAL IMPLICATIONS

                                        • Clinical Importance

                                          • Management of Lesions Detected on MR and CT

                                            • Management of Lesions Detected on FDG PET

                                              Selected References

                                              1. Chapman PR et al: Neuroimaging of the pituitary gland: practical anatomy and pathology. Radiol Clin North Am. 58(6):1115-33, 2020
                                              2. Barkhoudarian G et al: Pituitary apoplexy. Neurosurg Clin N Am. 30(4):457-63, 2019
                                              3. Mahdi ES et al: Prevalence of pituitary cysts in children using modern magnetic resonance imaging techniques. Pediatr Radiol. 49(13):1781-7, 2019
                                              4. Hoang JK et al: Management of incidental pituitary findings on CT, MRI, and 18F-Fluorodeoxyglucose PET: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 15(7):966-72, 2018
                                              5. Inoshita N et al: The 2017 WHO classification of pituitary adenoma: overview and comments. Brain Tumor Pathol. 35(2):51-6, 2018