What to Do with Incidentally Discovered Pituitary Abnormalities?

Med Clin North Am. 2021 Nov;105(6):1081-1098. doi: 10.1016/j.mcna.2021.05.015. Epub 2021 Sep 9.


Pituitary incidentalomas are discovered in approximately 10% to 40% of brain images. A complete patient history, physical examination, and dedicated pituitary function testing are needed, and subsequent results should lead to appropriate patient management. However, most lesions are asymptomatic pituitary adenomas or Rathke cleft cysts with a benign course. Many lesions can be clinically significant, including prolactinomas or other pituitary adenomas that warrant specific pituitary disease treatment. In other cases, mass effect causing visual compromise or refractory headache indicates a need for surgery. Here, various facets of a complex evaluation and treatment algorithm for pituitary incidentalomas are reviewed.

Keywords: Incidentaloma; Macroadenoma; Magnetic resonance imaging; Microadenoma; Pituitary adenoma; Prolactinomas; Rathke cleft cyst.

Publication types

  • Review

MeSH terms

  • Adenoma / diagnosis*
  • Adenoma / diagnostic imaging
  • Adenoma / pathology*
  • Adenoma / surgery
  • Diagnosis, Differential
  • Humans
  • Incidental Findings
  • Magnetic Resonance Imaging
  • Pituitary Diseases / diagnosis
  • Pituitary Diseases / pathology
  • Pituitary Gland / anatomy & histology
  • Pituitary Gland / metabolism*
  • Pituitary Neoplasms / diagnosis*
  • Pituitary Neoplasms / diagnostic imaging
  • Pituitary Neoplasms / pathology*
  • Pituitary Neoplasms / surgery