Background: Incidentally discovered pituitary lesions are a common problem in the endocrinology clinic due to increased access to detailed brain imaging. The challenge for endocrinologists is to determine which pituitary lesions are clinically significant and which are truly incidental. Pituitary micro-adenomas have been found at autopsy in 1.527% of subjects, whilst population-based radiological studies report small pituitary lesions in ~10%. It is difficult to produce consensus guidelines on this topic because the term incidentaloma is subjective and dependent upon clinicians pre-scan clinical suspicion of pituitary disease. The subject is further complicated by the possibility of sub-clinical pituitary hyper- and hypo-function, and the confounding variables that may affect the reliability of pituitary imaging.
Content of session: The wide range of approaches to the investigation and management of pituitary incidentalomas is highlighted by a recent survey completed by 214 consultants (76%) and registrars (34%) prepared specifically for this forum. A series of questions based on a previous survey were posed regarding the investigation and management of two theoretical case scenarios (Case 1: incidental micro-adenoma, Case 2: incidental macroadenoma). The format of this session will be a presentation of the survey results in the context of an up-to-date review of the recent literature, followed by an interactive discussion.