Last reviewed: 20 Sep 2021
Last updated: 05 Sep 2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • long-standing and progressing symptoms
  • headaches
  • erectile dysfunction
  • soft small testicles
  • gynaecomastia
  • amenorrhoea
  • infertility
  • breast atrophy
  • loss of libido
  • hot flushes
  • diaphoresis
  • weight gain
  • fatigue
  • anorexia
  • nausea
  • vomiting
  • weakness
  • decreased visual acuity
  • bitemporal hemianopia
  • pituitary apoplexy
  • diplopia

Other diagnostic factors

  • increased central adiposity
  • reduced muscle mass
  • constipation
  • cold intolerance
  • dry skin
  • hair loss
  • poor memory
  • low mood
  • osteopenia
  • weight loss
  • nervousness
  • facial numbness
  • imbalance
  • urinary incontinence
  • recurrent sinusitis
  • bradycardia
  • seizures

Risk factors

  • multiple endocrine neoplasia type 1 (MEN-1)
  • familial isolated pituitary adenomas (FIPA)
  • Carney complex (CNC)

Diagnostic investigations

1st investigations to order

  • prolactin
  • insulin-like growth factor 1
  • luteinising hormone, follicle-stimulating hormone
  • alpha subunit of human pituitary glycoprotein hormones
  • testosterone
  • estradiol
  • thyroid-stimulating hormone, free thyroxine
  • morning cortisol
  • adrenocorticotrophic hormone (ACTH) stimulation test
  • adrenocorticotrophic hormone
  • insulin tolerance test for cortisol
  • basic metabolic panel
  • FBC
  • MRI pituitary with gadolinium enhancement
  • contrast enhanced CT pituitary

Investigations to consider

  • growth hormone stimulation test
  • lipid panel
  • Humphrey or Goldmann formal visual fields test
  • immunohistochemical staining

Treatment algorithm

Contributors

Authors

Gabriel Zada, MD, MS

Assistant Professor of Neurosurgery

Otolaryngology and Internal Medicine

Co-Director, USC Pituitary Center

Co-Director, USC Radiosurgery Center

Director, USC Endoscopic Skull Base Surgery Program

Keck Medicine of USC

University of Southern California

Los Angeles

CA

Disclosures

GZ declares that he has no competing interests.

John Carmichael, MD

Associate Professor of Clinical Medicine

Co-director, USC Pituitary Center

Keck Medicine at USC

University of Southern California

Los Angeles

CA

Disclosures

JC holds an unpaid position on the editorial board of Pituitary. JC is also a Principal Investigator in the research he undertakes and which is funded by: Novo Nordisk, Chiasma, Novartis, Strongbridge, Milendo, Pfizer, and Crinetics.

Acknowledgements

Dr Gabriel Zada and Dr John Carmichael would like to gratefully acknowledge Dr Israel Orija and Dr Amir H. Hamrahian, previous contributors to this topic. IO and AH declare that they have no competing interests.

Peer reviewers

Andrew James, BSc, MB BCh, MD, MRCP, FRCP

Consultant Endocrinologist

Newcastle Hospitals NHS Foundation Trust

Royal Victoria Infirmary

Newcastle

UK

Disclosures

AJ declares that he has no competing interests.

Federico Roncaroli, MD

Reader in Neuropathology and Honorary Consultant in Neuropathology

Neuropathology Unit

Department of Clinical Neuroscience

Division of Neuroscience and Mental Health

Faculty of Medicine

Imperial College

London

UK

Disclosures

FR declares that he has no competing interests.

Roberto Salvatori, MD

Associate Professor of Medicine

Division of Endocrinology

Johns Hopkins University

Baltimore

MD

Disclosures

RS declares that he has no competing interests.

Laurence Kennedy, MD, FRCP

Professor and Chief

Chairman

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic

Cleveland

OH

Disclosures

LK declares that he has no competing interests.

Shereen Ezzat, MD

Professor of Medicine and Oncology

University of Toronto

Toronto

Ontario

Canada

Disclosures

SE declares that he has no competing interests.

Laurence Katznelson, MD

Associate Professor

Stanford University

Palo Alto

CA

Disclosures

LK declares that he has no competing interests.

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