The Curbsiders Internal Medicine Podcast #513 Pituitary Incidentalomas
31 snips
Feb 2, 2026 Dr. Maria Fleseriu, professor and pituitary specialist who directs a major Pituitary Center, walks through managing unexpected pituitary findings. She explains micro vs macro lesions, essential hormonal testing, and when imaging or surgery is needed. Practical advice on visual field testing, empty sella assessment, and follow-up strategies keeps clinicians confident and efficient.
AI Snips
Chapters
Transcript
Episode notes
Assess Optic Chiasm Proximity And Visual Fields
- When you find a pituitary lesion, review the dedicated imaging and note proximity to the optic chiasm as this alters risk.
- Refer for formal visual fields if the lesion is suprasellar or near the optic chiasm.
Incidentalomas Are Common, Usually Benign
- Pituitary incidentalomas are common and often benign; autopsy/imaging studies suggest prevalence around 10%.
- Many small lesions were previously missed and now appear more often with better imaging.
Screen For Hypopituitarism Early
- Do check morning cortisol and ACTH to screen for central adrenal insufficiency in pituitary lesions.
- Do measure free T4 alongside TSH to avoid missing central hypothyroidism.