From the Guidelines
MRI surveillance for pituitary macroadenomas should be performed at 6 months and, if stable, annually for 3 years with gradual reduction thereafter, as per the Endocrine Society guidelines. This recommendation is based on the recent consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence, published in Nature Reviews Endocrinology in 2024 1. The guideline suggests that for macroincidentalomas, MRI surveillance should be done at 6 months and, if stable, annually for 3 years with gradual reduction thereafter.
The natural history of non-functioning pituitary adenomas (NFPAs) in children and young people (CYP) is unknown, but in adults, macroadenomas tend to have higher growth rates than microadenomas 1. Therefore, lifelong clinical surveillance with an individualized radiological (MRI) surveillance strategy is recommended to identify those with rapid tumor progression or post-operative recurrence early, even if asymptomatic.
Key points to consider when determining the frequency of MRI surveillance for pituitary macroadenomas include:
- Tumor size and growth rate
- Proximity to critical structures like the optic chiasm
- Response to treatment
- Individual patient factors, such as age and overall health
Visual surveillance in patients with either operated or incidental macroadenomas should be adjusted to their individual needs, and concerns regarding repeated gadolinium administration over prolonged imaging follow-up should be taken into account 1. The radiological surveillance of stable non-functioning microadenomas can cease after 1–3 years, but macroadenomas need to be followed in the long term, with a decreasing scanning interval for adenomas proven stable over the years 1.
From the Research
Frequency of MRI for Pituitary Macroadenoma
- The frequency of MRI for pituitary macroadenoma is not explicitly stated in the provided studies as per the Endocrine society guidelines 2, 3, 4, 5, 6.
- However, it is mentioned that magnetic resonance imaging (MRI) is the examination of choice for diagnosing and monitoring pituitary adenoma, and repeating the examination too often can be costly and may lead to tissue accumulation of gadolinium atoms 2.
- The studies suggest that the optimal frequency for pituitary MRI monitoring depends on the type, size, and location of the pituitary tumor, as well as the clinical situation 2, 4, 5.
- For example, patients with macroadenomas may require more frequent MRI monitoring due to the risk of mass effect and visual field defects 4, 5.
- In contrast, patients with microadenomas may require less frequent monitoring, unless they are symptomatic or have a history of tumor growth 4, 5.
- The studies also emphasize the importance of individualized treatment plans and monitoring strategies for patients with pituitary adenomas, taking into account their specific clinical characteristics and needs 3, 4, 5, 6.