Summary
Definition
History and exam
Key diagnostic factors
- longstanding and progressing symptoms
- headaches
- erectile dysfunction
- soft small testicles
- gynecomastia
- amenorrhea
- infertility
- breast atrophy
- loss of libido
- hot flashes
- 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
- adrenocorticotropic hormone stimulation test
- adrencorticotropic hormone
- insulin tolerance test for cortisol
- basic metabolic panel
- CBC
- 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
pituitary apoplexy
microadenoma
macroadenoma without mass effect and not abutting optic chiasm
macroadenoma without mass effect but abutting optic chiasm
macroadenoma with mass effect
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.
Differentials
- Prolactin-secreting adenoma (prolactinoma)
- Growth hormone-secreting adenoma (acromegaly)
- Adrenocorticotropic hormone-secreting adenoma (Cushing syndrome)
More DifferentialsGuidelines
- Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline
- Pituitary incidentaloma: an Endocrine Society clinical practice guideline
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