AbstractOBJECTIVE:To evaluate therapeutic strategy for incidentally found pituitary tumors (“pituitary incidentalomas”), we -analyzed the results of magnetic resonance imaging findings and of ophthalmological and endocrinological-studies in 28 cases with long-term follow-up (Hardy's classification : Grade A, 24 cases; Grade B, 4 cases).METHODS:Only cases of non functioning macro incident alom a were analyzed in this study. Cases with ophthalmological and/or endocrinologicaldys functionrevealed by the first evaluation, even with out subjective manifestations, were excludedfrom the category. Incidentally found functioning tumors were also excluded.RESULTS:The follow-up periodranged from 6 months to 10 years (mean, 5.6 yr). M agneticresonance imaging and ophthalmological and endocrinological studies, including provocation tests, were conducted once peryear.No surgical treatment was required in any case of Grade A tumors and in two cases of Grade B tumors because of no changes revealed by these studies. Transsphenoidal surgery was performed in the remain ng two cases of Grade B tumors because of pituitary apoplexy. The second case was one of head injury-induced apoplexy. There were no deficits after surgery. The MIB-1 index did not differ in operated incidentaloma and symptomatic pituitary tumors.CONCLUSION:Unless ophthalmological and endocrinological function is noted, surgical treatment is not required for Grad e A pituitary in identalomas. It is not too late toremove the tumor surgically, even after some function develops. A patient having a tumor larger than Grade A can still be managed conservatively; however, the patient should be care fully informed of the possibility of pituita ry apoplexy, and emergency transsphenoidal surgery is indicated if apoplexy occurs. (Neurosurgery 43 :1344–1350, 1998)
Neurosurgery – Oxford University Press
Published: Dec 1, 1998
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