Pituitary adenoma

Last reviewed: 23 Aug 2023
Last updated: 30 Mar 2023

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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

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

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
  • adrenocorticotropic hormone
  • insulin tolerance test for cortisol
  • basic metabolic panel
  • CBC
  • MRI pituitary with gadolinium enhancement
  • contrast-enhanced CT pituitary
More 1st investigations to order

Investigations to consider

  • growth hormone stimulation test
  • lipid panel
  • Humphrey or Goldmann formal visual fields test
  • immunohistochemical staining
More investigations to consider

Treatment algorithm

ACUTE

pituitary apoplexy

ONGOING

microadenoma

macroadenoma without mass effect and not abutting optic chiasm

macroadenoma without mass effect but abutting optic chiasm

macroadenoma with mass effect

Contributors

Authors

Susmeeta Tewari Sharma, MD, MBBS, MHSc

Director of Pituitary Endocrinology

MedStar Washington Hospital Center/Georgetown University Hospital

Washington

DC

Disclosures

STS declares that she has no competing interests.

Acknowledgements

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

Peer reviewers

S. Bulent Omay, MD

Assistant Professor of Neurosurgery

Yale Medical School

New Haven

CT

Disclosures

SBO declares that he has no competing interests.

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.

  • Pituitary adenoma images
  • Differentials

    • Prolactin-secreting adenoma (prolactinoma)
    • Growth hormone-secreting adenoma (acromegaly)
    • Adrenocorticotropic hormone-secreting adenoma (Cushing syndrome)
    More Differentials
  • Guidelines

    • Clinical practice guideline on functioning and nonfunctioning pituitary adenomas in pregnancy
    • Appropriateness Criteria: neuroendocrine imaging
    More Guidelines
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