Background: With advances in radiological technology, the detection of incidentally discovered pituitary abnormalities is increasing, 90% being secondary to pituitary adenomas. Patient morbidity increases when these lesions are large enough to cause hormone insufficiency or visual field defects, highlighting the importance of appropriate management.
Aim: To evaluate management of patients with pituitary incidentaloma in accordance with national guidelines at Lincoln County Hospital.
Methods: A guideline on management of pituitary incidentaloma was identified within The Journal of Endocrinology & Metabolism. A retrospective data collection was obtained for 50 service users attending endocrinology clinics with pituitary incidentaloma from 2014 to 2019.
Results: At initial clinic presentation, 100% of patients underwent full history and examination and 90% (45/50) had clinical & laboratory evaluation for hormone hypersecretion and hypopituitarism. 92% (46/50) had MRI evaluation of the lesion. 34% (17/50) of these patients had a lesion abutting the optic chiasm on MRI, of which 71% (12/17) had visual field assessment within initial consultation. At follow up, MRI imaging was repeated at 6 months in 46% (19/41) of macroadenomas and at 12 months in 44% (4/9) of microadenomas. Visual field re-evaluation for chiasmal compressive lesions at 6 months was 41% (7/17) and 53% (9/17) at 12 months. Repeat biochemistry at 6 months was 63% (26/41) and 73% (30/41) at 12 months. Repeat MRI following symptomatic progression was 100%.
Conclusion: Visual field assessment is an important predictor of morbidity in pituitary incidentaloma and these results highlight that 29% of patients didnt have this assessed at initial evaluation. A proforma has been introduced within the endocrinology clinic to allow concurrent visual field assessment by ophthalmology during initial consultation. This project shall be re-audited in 1 year, with conformance to guidelines and patient satisfaction being used as outcomes of re-evaluation.