Characteristics and Treatment Outcomes of Incidental Pituitary Adenomas: an Analysis of 102 Patients over 18 Years

Introduction: Pituitary incidentalomas are pituitary masses found incidentally in the course of evaluations for unrelated reasons. They are common and are often found at autopsy or on head imaging. Most are nonfunctional pituitary adenomas (PAs) and clinically insignificant, allowing for observation without intervention. However, a small number can grow large enough to cause endocrinopathies and/or endanger the optic chiasm, requiring resection.

Methods: Patient data for surgically resected PAs from a single quaternary referral center over an 18-year period (1997–2015) were collected and placed into a database. Cases of incidental PAs were then selected from this database, generating 102 cases.

Results: Median age at surgery was 57.9 years for males and 58.6 years for females. Median follow up was 31 months. Most were asymptomatic but the most common symptoms were headache, vision loss, decreased libido, and fatigue. Sixty-eight had normal physical exams; the most common finding was a visual field deficit by formal testing.

Seventy-two achieved gross total resection. Fourteen had improved endocrine function, 13 had improved vision, and 9 had improved headaches. Ninety-one had macroadenomas, the majority of which had suprasellar and/or cavernous sinus extension. Mean tumor diameter was 21.3mm. Sixty-seven required intraoperative CSF leak repair and 4 required postoperative CSF leak repair. Two had meningitis. Eighty-five had no complications. There were no incidents of carotid artery injury, paresis, coma, or death. Median hospital stay was 2 days. Twenty-one patients received adjunctive radiosurgery and 4 patients had recurrence requiring additional surgery.

Conclusions: Large incidental PAs can pose a high risk to endocrine function and vision and should be evaluated and treated without significant delay. Different guidelines present different thresholds for observation times and surgical urgency. However, surgical treatment of incidental PAs, when appropriate, can be performed safely with outcomes consistent with surgery for symptomatic PAs.