Fig. 1: An algorithm for assessment of an incidentally discovered pituitary adenoma on imaging managed conservatively.

Type of assessment to be performed and timing of assessment depend on clinical and tumour features. If initial imaging was a brain MRI or CT, dedicated pituitary MRI with specific sequences is desired in most cases. Patients should undergo pituitary function testing at presentation to rule out hypopituitarism and/or hormone hypersecretion and should undergo visual assessment (including visual field testing). Further repeat evaluation depends on adenoma size and proximity to the optic chiasm. If a microadenoma <5 mm in size remains stable on repeat MRIs performed at intervals of 2–3 years, reassess the need for continued imaging. For macroadenomas and microadenomas <5 mm from the optic chiasm, visual field testing could be performed in the interval between MRIs done after 6–12 months. Evaluation and follow-up for cystic lesions, cystic adenomas, or other sellar or parasellar masses, including Rathke cleft cyst and craniopharyngiomas, should be individualized based on both patient and lesion characteristics. *We recommend that patients with documented hormone hypersecretion or hypopituitarism be followed up as per current guidelines. **CT of head and/or sella might help confirm a diagnosis of craniopharyngioma, chordoma or other non-pituitary lesions.