The Pituitary Incidentaloma Beyond the First Year of Follow-up

To the Editor.—  Reincke et al¹ coin the term incidentaloma to describe those pituitary tumors serendipitously detected on magnetic resonance imaging or computed tomographic scan and provide guidelines for their evaluation and treatment. We agree that modern noninvasive neuroimaging has revolutionized the approach to these and all pituitary tumors, making a conservative approach, as they suggest, more tenable. Nonetheless, we disagree with their recommendation that if a patient has a tumor less than 1 cm in size and normal visual fields and pituitary function, and on repeated magnetic resonance imaging at 1 year there is no interval change in tumor size, then no further studies are necessary. We have had experience with small pituitary tumors (as well as other parasellar tumors initially misdiagnosed as pituitary tumors before histopathologic examination) that, although the above criteria were met at 1 year, went on to enlarge and produce chiasmal compression and visual