Pituitary incidentalomas

The widespread use of sensitive neuroradiological imaging studies (i.e. computed tomography scan and magnetic resonance imaging) over the last years lead to the diagnosis of an increased number of asymptomatic pituitary lesions. The management of these so-called "pituitary incidentalomas" is still controversial, due to the limited data so far available on both the clinical relevance and the natural history of such incidentally discovered pituitary masses. Most pituitary incidentalomas are less than 1 cm in diameter (microincidentalomas) and are pituitary adenomas. Although these tumours are in general hormonally inactive, all the patients with incidentalomas should be screened for pituitary hypo- or hyper-function. Macroincidentalomas have greater growth potential and, when associated with hypopituitarism and/or visual disturbances, should be surgically removed. Conversely, incidentalomas not associated with hormonal alterations and dimensionally stable could be managed conservatively. This review will focus on the last data on the natural history and clinical management of pituitary incidentalomas.