Surveillance imaging strategies for pituitary adenomas: when, how frequent and when to stop

Authors

Kevin C. Yuen, Department of Neuroendocrinology and Neurosurgery, Barrow Pituitary Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix, Arizona, Unites States; University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, United States. Electronic address: kevin.yuen@dignityhealth.org.
Luma Ghalib, The James Comprehensive Skull Base and Pituitary Centre, Division of Endocrinology, The Ohio State University, Ohio, United States.
Michael Buchfelder, Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany.
Jeremy Hughes, Department of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States.Follow
Fabienne Langlois, Division of Endocrinology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
Mark E. Molitch, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.

Document Type

Article

Abstract

Magnetic resonance imaging is the mainstay imaging modality of choice in the assessment, treatment planning and follow-up of pituitary adenomas (PAs). Pituitary adenomas are discovered incidentally during imaging for a variety of unrelated conditions, because of clinical symptoms related to mass effects on the adjacent structures, or during work up for functional alterations of the adenoma. Imaging is also utilized in the preoperative and postoperative phases of assessment of PAs, for surgical and radiotherapy planning, for postoperative surveillance to assess for adenoma stability and detection of adenoma recurrence, and for surveillance to monitor for adenoma growth in unoperated PAs. Currently, because there are no evidence-based consensus recommendations, the optimal strategy for surveillance imaging of PAs is not clearly established. Younger age, initial adenoma size, extra-sellar extension, mass effect, cavernous sinus invasion, functional status, histopathologic characteristics, cost considerations, imaging accessibility, patient preference and patient contraindications (e.g., implanted metallic devices and patient claustrophobia) are all important factors that influences the strategy for surveillance imaging. This review focuses on when to image, how often to perform imaging, and when to stop imaging PAs. Due to the lack of evidence pertaining to the natural history of many PAs, the recommendations provided are largely expert-opinion based and should be individualized based on clinical presentation, history, adenoma morphology on imaging and histopathologic characteristics.

Publication Date

12-29-2023

Publication Title

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

ISSN

1530-891X

PubMed ID

38160940

Digital Object Identifier (DOI)

10.1016/j.eprac.2023.12.014

Recommended Citation

Yuen, Kevin C.; Ghalib, Luma; Buchfelder, Michael; Hughes, Jeremy; Langlois, Fabienne; and Molitch, Mark E., "Surveillance imaging strategies for pituitary adenomas: when, how frequent and when to stop" (2023). Neuroradiology. 89.
https://scholar.barrowneuro.org/neuroradiology/89