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November 14, 1990

The Pituitary Incidentaloma Beyond the First Year of Follow-up-Reply

Author Affiliations

University of Cologne West Germany

University of Cologne West Germany

JAMA. 1990;264(18):2387. doi:10.1001/jama.1990.03450180043024

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In Reply.—  Drs Frohman, Kupersmith, and Warren provide important additional information on the conservative approach to patients with incidentally discovered small pituitary tumors. They describe several patients with lesions less than 1 cm in diameter and no increase in tumor size during the first year of follow-up who experienced later tumor enlargement and compression of the optic nerve.Although we did not observe a similar case in a total of 30 patients with incidentalomas treated conservatively (14 patients in our initial series, 16 additional patients studied since 1988), unexpected late tumor growth certainly may occur in a small percentage of these patients. However, our preliminary results demonstrate that the great majority of incidentalomas remain asymptomatic and stable during follow-up. Nevertheless, close surveillance seems to be necessary for more than a year. Since yearly magnetic resonance imaging or computed tomographic scans should be avoided, we recommend clinical follow-up studies (for