Management of Radiology Incidental Findings in the Pituitary

Based on recommendations by the American College of Radiology (ACR), published as guidelines (white papers)
Incidental: pituitary
What is the imaging modality?
Can you evaluate the composition, size, and mass effect?
What is the composition of the pituitary finding?
Which one best describes the patient?
What is the composition of the pituitary finding?
Is there mass effect and/or invasion into surrounding structures?
What is the maximum dimension of the finding?
Is there mass effect and/or invasion into surrounding structures?
Characterize with pituitary MRI
Referral for endocrine and/or neurosurgical management
Recommend endocrine function tests.
6-12 months follow-up pituitary MRI
No further imaging.
Correlate with history of pituitary hypersecretion, and consider the possibility of a pseudolesion given the lesion's size.
No further imaging.
Correlate with history of pituitary hypersecretion, and consider endocrine function tests.
No further evaluation

Click here to visit the incidental findings page on ACR.

References:

  1. Hoang, J. K., Hoffman, A. R., González, R. G., Wintermark, M., Glenn, B. J., Pandharipande, P. V., Berland, L. L., & Seidenwurm, D. J. (2018). Management of Incidental Pituitary Findings on CT, MRI, and 18F-Fluorodeoxyglucose PET: A White Paper of the ACR Incidental Findings Committee. Journal of the American College of Radiology : JACR, 15(7), 966–972. https://doi.org/10.1016/j.jacr.2018.03.037

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