This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chanson, P. Articles by Schaison, G. Search for Related Content PubMed PubMed Citation Articles by Chanson, P. Articles by Schaison, G.

Normal Pituitary Hypertrophy as a Frequent Cause of Pituitary Incidentaloma: A Follow-Up Study

Service d’Endocrinologie et des Maladies de la Reproduction (P.C., F.D., J.Y., G.S.), and Service de Neuroradiologie (A.B., D.D.), Centre Hospitalier Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, and Faculté de Médecine Paris-Sud, F-94275 Le Kremlin-Bicêtre, and Laboratoire d’Histologie-Embryologie (M.K.), Faculté de Médecine Pitié-Salpêtrière, F-75013 Paris, all in France

Address all correspondence and requests for reprints to: Dr. Philippe Chanson, Service d’Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du Général Leclerc, F-94275 Le Kremlin-Bicêtre, France. E-mail: pchanson{at}club-internet.fr

Abstract

Enlargement of the pituitary gland is a frequent cause of incidentaloma and of referrals to endocrinologists for hormonal evaluation and therapeutic advice. In neuroradiological series, 25–50% of healthy women who are 18–35 yr old have a convex superior pituitary contour, but pituitary height exceeds 9 mm in less than 0.5% of cases.

This study was performed to provide thorough clinical and hormonal data and long-term endocrinological and imaging follow-up data on subjects with incidentally discovered pituitary hypertrophy (height > 9 mm). Seven eugonadal nulliparous women, 15–27 yr old, referred between 1989 and 1998 with incidentally diagnosed pituitary gland enlargement (height > 9 mm) and a suspected pituitary tumor, were studied. At presentation and at yearly intervals, PRL plasma levels and corticotropic, somatotropic, and thyrotropic pituitary function were measured; and pituitary dimensions and signal on magnetic resonance imaging (MRI), before and after iv gadolinium-diethylene-triamine-pentaacetic acid injection, were assessed.

PRL plasma levels were normal; and corticotropic, somatotropic, and thyrotropic pituitary function was considered normal in all cases. In all the women, the upper boundary of the pituitary was convex, on MRI, and touched the optic chiasm in four cases. The width and anteroposterior diameter of the gland were normal. The pituitary itself seemed normal, with a homogeneous signal, on plain and dynamic studies with iv contrast injection. Despite normal initial hormone values, two women underwent surgery, by the transsphenoidal approach, in another center. During surgery, the pituitary seemed normal in both cases, with no evidence of tumoral or inflammatory processes. Biopsy specimens showed the morphologic characteristics of a normal, nonhyperplastic pituitary gland. All seven women were seen at yearly intervals for 2–8 yr (median, 4 yr). Clinical and hormonal status remained stable, as did the structure and size of pituitary, on serial MRI. No tumor formation occurred, supporting the diagnosis of physiologic hypertrophy of the pituitary gland.

In conclusion, these observations suggest that careful examination of MRI results may help to distinguish physiologic pituitary hypertrophy from pituitary tumors and infiltrating lesions. The former diagnosis is confirmed by normal baseline pituitary function in extensive hormonal tests. Correct identification of such patients is important to avoid unnecessary pituitary surgery and costly MRI surveillance.

This article has been cited by other articles:

				O M Dekkers, S Hammer, R J W de Keizer, F Roelfsema, P J Schutte, J W A Smit, J A Romijn, and A M Pereira The natural course of non-functioning pituitary macroadenomas Eur. J. Endocrinol., February 1, 2007; 156(2): 217 - 224. [Abstract] [Full Text] [PDF]

				S. Salenave, B. Gatta, S. Pecheur, F. San-Galli, A. Visot, P. Lasjaunias, P. Roger, J. Berge, J. Young, A. Tabarin, et al. Pituitary Magnetic Resonance Imaging Findings Do Not Influence Surgical Outcome in Adrenocorticotropin-Secreting Microadenomas J. Clin. Endocrinol. Metab., July 1, 2004; 89(7): 3371 - 3376. [Abstract] [Full Text] [PDF]