Incidence of Pituitary Incidentalomas in Patients with Adrenal Adenomas

Abstract

With the advent of modern imaging modalities, endocrine incidentalomas are increasingly being discovered. We aimed to investigate the presence of pituitary incidentalomas (PI) in patients with adrenal incidentalomas (AI), and identify potential metabolic correlates in this cohort. 26 patients (18 females) with AI discovered on abdominal computerized tomography were studied. All patients underwent pituitary magnetic resonance imaging (MRI) and endocrine investigations to evaluate functional adrenal pathology, anterior pituitary hormonal status, insulin-resistance indices and presence of metabolic syndrome. Pituitary MRI revealed a microadenoma and a 4×5 mm cyst in 1 patient respectively, and an empty sella in 4 (2 partial) patients. Overall, 6/26 (23%) patients with an AI had evidence of pituitary imaging pathology but only 8% had a PI; none had any evidence of abnormalities in pituitary function. Subclinical hypercortisolism was the only hyperfunctional status detected in 4 patients with AI but was unrelated to the pituitary findings. No abnormality of insulin secretion and action was found between patients with or without pituitary pathology. In the present study 23% of patients with AI had some alteration in pituitary morphology, and 2 a PI without accompanying pituitary hormonal deficit or metabolic derangement. Further studies are required to address this issue and identify a potential pathogenetic mechanism.

Key words

pituitary incidentalomas - adrenal incidentalomas - insulin resistance - beta-cell function

• References

• 1 Grumbach MM, Biller BMK, Βraunstein GD et al. Management of the clinically inapparent adrenal mass (incidentaloma). Ann Intern Med 2003; 138: 424-429
• 2 Terzolo M, Pia A, Alì A et al. Adrenal incidentaloma: a new cause of the metabolic syndrome?. J Clin Endocrinol Metab 2002; 87: 998-1003
• 3 Aron DC, Howlett TA. Pituitary incidentalomas. Endocrinol Metab Clin North Am 2000; 29: 205-221
• 4 Batista D, Gennari M, Riar J et al. An assessment of petrosal sinus sampling for localization of pituitary microadenomas in children with Cushing’s disease. J Clin Endocrinol Metab 2006; 91: 221-224
• 5 Hall WA, Luciano MG, Doppman JL et al. Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Intern Med 1994; 120: 817-820
• 6 Donovan LE, Corenblum B. The natural history of the pituitary incidentaloma. Arch Intern Med 1995; 155: 181-183
• 7 Freda PU, Beckers AM, Katznelson L et al. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 894-904
• 8 Rossi R, Tauchmanova L, Luciano A et al. Subclinical Cushing’s syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab 2000; 85: 1440-1448
• 9 Kaltsas G, Chrisoulidou A, Piaditis G et al. Current status and controversies in adrenal incidentalomas. Trends Endocrinol Metab 2012; 23: 602-609
• 10 Reincke M, Allolio B, Saeger W et al. The “incidentaloma” of the pituitary gland: is neurosurgery required?. JAMA 1990; 263: 2772-2776
• 11 Midorikawa S, Sanada H, Hashimoto S et al. The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection. Clin Endocrinol (Oxf) 2001; 54: 797-804
• 12 Fernádez-Real JM, Engel WR, Simó R et al. Study of glucose tolerance in consecutive patients harboring incidental adrenal tumors. Clin Endocrinol (Oxf) 1998; 49: 53-61
• 13 Eisenhofer G, Lenders JWM, Pacak K. Biochemical diagnosis of pheochromocytoma. Front Horm Res 2004; 31: 76-106
• 14 Chiodini I, Morelli V, Salcuni AS et al. Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hyperortisolism. J Clin Endocrinol Metab 2010; 95: 2736-2745
• 15 Rosenzweig JL, Ferrannini E, Grundy SM et al. Endocrine Society . Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93: 3671-3689
• 16 Goldberg AC, Hopkins PN, Toth PP et al. Familial hypercholesterolemia: screening, diagnosis and management of pediatric and adult patients: clinical guidance from the National Lipid Association Expert Panel on Familial Hypercholesterolemia. J Clin Lipidol 2011; 5: 133-140
• 17 Alexandraki KI, Makras P, Protogerou AD et al. Cardiovascular risk factors in adult patients with multisystem Langerhans-cell histiocytosis: evidence of glucose metabolism abnormalities. QJM 2008; 101: 31-40
• 18 Le Floch JP, Escuyer P, Baudin E et al. Blood glucose area under the curve. Methodological aspects. Diabetes Care 1990; 13: 172-175
• 19 Matsuda M, DeFronzo RA. Insulin Sensitivity Indices Obtained From Oral Glucose Tolerance Testing. Comparison with the Euglycemic Insulin Clamp. Diabetes Care 1999; 22: 1462-1470
• 20 Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care 2004; 27: 1487-1495
• 21 Belli SH, Graffigna MN, Oneto A et al. Effect of rosiglitazone on insulin resistance, growth factors, and reproductive disturbances in women with polycystic ovary syndrome. Fertil Steril 2004; 81: 624-629
• 22 Serhal D, Weil RJ, Hamrahian AH. Evaluation and management of pituitary incidentalomas. Cleve Clin J Med 2008; 75: 793-801
• 23 Daly A, Burlacu MC, Livadariu E et al. The epidemiology and management of pituitary incidentalomas. Horm Res 2007; 68: 195-198
• 24 Manavela MP, Goodall CM, Katz SB et al. The association of Cushing’s disease and primary empty sella turcica. Pituitary 2001; 4: 145-151
• 25 Komada H, Yamamoto M, Okubo S et al. A case of hypothalamic panhypopituitarism with empty sella syndrome: case report and review of the literature. Endocr J 2009; 56: 585-589
• 26 Barzon L, Sonino N, Fallo F et al. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 2003; 149: 273-285
• 27 Muscogiuri G, Sorice GP, Prioletta A et al. The size of adrenal incidentalomas correlates with insulin resistance. Is there a cause-effect relationship?. Clin Endocrinol (Oxf) 2011; 74: 300-305
• 28 Peppa M, Boutati E, Koliaki C et al. Insulin resistance and metabolic syndrome in patients with nonfunctioning adrenal incidentalomas: a cause-effect relationship?. Metabolism 2010; 59: 1435-1441