Summary
Definition
History and exam
Key diagnostic factors
- visual loss
- macrocephaly and hydrocephalus
- growth failure
Other diagnostic factors
- symptoms of hypogonadotrophic hypogonadism (amenorrhoea, erectile dysfunction)
- headache
- symptoms of intracranial hypertension (nausea, vomiting, decreased sensorium, diplopia)
- galactorrhoea
- optic atrophy
- polyuria/polydipsia
Diagnostic investigations
1st investigations to order
- MRI brain (contrast-enhanced)
- CT brain (contrast-enhanced)
- serum prolactin
- serum growth hormone (GH)
- serum insulin-like growth factor 1 (IGF-1)
- serum insulin-like growth factor binding protein-3 (IGFBP-3)
- provocative GH tests
- serum LH
- serum FSH
- morning serum testosterone
- serum TSH and T3/T4
- morning serum cortisol and ACTH
- serum electrolytes
- urine and serum osmolality
- urine specific gravity
- ophthalmological evaluation; computerised visual-field examination
- plain x-rays for bone age
Treatment algorithm
Contributors
Authors

Chief
Division of Neuro-Oncology
Department of Neurology and Neurological Surgery
University of Washington
Seattle Cancer Care Alliance
Seattle
WA
Disclosures
MCC declares that he has no competing interests.

Professor of Neurological Surgery and Pathology (Neuropathology)
University of Washington
Seattle
WA
Disclosures
DLS declares that he has no competing interests.
Peer reviewers
Professor of Neurology
Department of Neurology
University of Michigan
Ann Arbor
MI
Disclosures
LJ declares that he has no competing interests.
Associate Professor of Neurology
Director of Medical Neuro-Oncology
Northwestern University
Chicago
IL
Disclosures
JR declares that he has no competing interests.
Consultant Neurosurgeon
Addenbrooke's Hospital
Cambridge University Hospitals NHS Foundation Trust
Cambridge
UK
Disclosures
RK declares that he has no competing interests.
Consultant Neurosurgeon and Lead of Neuro-Oncology
King's College Hospital
London
UK
Disclosures
KA declares that he has no competing interests.
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