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Adenoma hipofisário

Last reviewed: 21 Jul 2025
Last updated: 30 Mar 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • sintomas progressivos e prolongados
  • cefaleias
  • disfunção erétil
  • testículos pequenos e moles
  • ginecomastia
  • amenorreia
  • infertilidade
  • atrofia da mama
  • perda da libido
  • fogacho
  • diaforese
  • ganho de peso
  • fadiga
  • anorexia
  • náuseas
  • vômitos
  • fraqueza
  • acuidade visual reduzida
  • hemianopsia bitemporal
  • apoplexia hipofisária
  • diplopia
Full details

Other diagnostic factors

  • adiposidade central elevada
  • massa muscular reduzida
  • constipação
  • intolerância ao frio
  • pele ressecada
  • queda de cabelos
  • dificuldades de memória
  • humor deprimido
  • osteopenia
  • perda de peso
  • nervosismo
  • dormência facial
  • desequilíbrio
  • incontinência urinária
  • sinusite recorrente
  • bradicardia
  • convulsões
Full details

Risk factors

  • neoplasia endócrina múltipla tipo 1 (NEM-1)
  • adenomas hipofisários familiares isolados (FIPA)
  • complexo de Carney (CNC)
Full details

Diagnostic tests

1st tests to order

  • prolactina
  • fator de crescimento semelhante à insulina-1
  • hormônio luteinizante, hormônio folículo-estimulante
  • subunidade alfa de hormônios glicoproteicos hipofisários
  • testosterona
  • estradiol
  • hormônio estimulante da tireoide, tiroxina livre
  • cortisol matinal
  • teste de estímulo com o hormônio adrenocorticotrófico (ACTH)
  • hormônio adrenocorticotrófico
  • teste de tolerância à insulina para cortisol
  • perfil metabólico básico
  • Hemograma completo
  • ressonância nuclear magnética (RNM) da hipófise com contraste de gadolínio
  • TC com contraste da hipófise
Full details

Tests to consider

  • teste de estímulo do hormônio do crescimento
  • perfil lipídico
  • teste formal do campo visual de Humphrey ou Goldmann
  • coloração imuno-histoquímica
Full details

Treatment algorithm

ACUTE

apoplexia hipofisária

ONGOING

microadenoma

macroadenoma sem efeito de massa e não contíguo ao quiasma óptico

macroadenoma sem efeito de massa, mas contíguo ao quiasma óptico

macroadenoma com efeito de massa

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA. 2017 Feb 7;317(5):516-24. Abstract

Mercado M, Melgar V, Salame L, et al. Clinically non-functioning pituitary adenomas: pathogenic, diagnostic and therapeutic aspects. [in spa]. Endocrinol Diabetes Nutr. 2017 Aug-Sep;64(7):384-95. Abstract

Aghi MK, Chen CC, Fleseriu M, et al. Congress of neurological surgeons systematic review and evidence-based guidelines on the management of patients with nonfunctioning pituitary adenomas: executive summary. Neurosurgery. 2016 Oct;79(4):521-3.Full text  Abstract

Esposito D, Olsson DS, Ragnarsson O, et al. Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management. Pituitary. 2019 Aug;22(4):422-34.Full text  Abstract

Minniti G, Flickinger J. The risk/benefit ratio of radiotherapy in pituitary tumors. Best Pract Res Clin Endocrinol Metab. 2019 Apr;33(2):101269. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Adenoma hipofisário images
  • Differentials

    • Adenoma secretor de prolactina (prolactinoma)
    • Adenoma secretor de hormônio do crescimento (acromegalia)
    • Adenoma secretor de hormônio adrenocorticotrófico (síndrome de Cushing)
    More Differentials
  • Guidelines

    • Suspected cancer: recognition and referral
    • Clinical practice guideline on functioning and nonfunctioning pituitary adenomas in pregnancy
    More Guidelines
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