Abstract
With the advent of modern imaging modalities, endocrine incidentalomas are increasingly
being discovered. We aimed to investigate the presence of pituitary incidentalomas
(PI) in patients with adrenal incidentalomas (AI), and identify potential metabolic
correlates in this cohort. 26 patients (18 females) with AI discovered on abdominal
computerized tomography were studied. All patients underwent pituitary magnetic resonance
imaging (MRI) and endocrine investigations to evaluate functional adrenal pathology,
anterior pituitary hormonal status, insulin-resistance indices and presence of metabolic
syndrome. Pituitary MRI revealed a microadenoma and a 4×5 mm cyst in 1 patient respectively,
and an empty sella in 4 (2 partial) patients. Overall, 6/26 (23%) patients with an
AI had evidence of pituitary imaging pathology but only 8% had a PI; none had any
evidence of abnormalities in pituitary function. Subclinical hypercortisolism was
the only hyperfunctional status detected in 4 patients with AI but was unrelated to
the pituitary findings. No abnormality of insulin secretion and action was found between
patients with or without pituitary pathology. In the present study 23% of patients
with AI had some alteration in pituitary morphology, and 2 a PI without accompanying
pituitary hormonal deficit or metabolic derangement. Further studies are required
to address this issue and identify a potential pathogenetic mechanism.
Key words
pituitary incidentalomas - adrenal incidentalomas - insulin resistance - beta-cell
function
