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Pituitary adenoma

Última revisão: 21 Aug 2025
Última atualização: 30 Mar 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • 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
Detalhes completos

Outros fatores diagnósticos

  • 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
Detalhes completos

Fatores de risco

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

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • 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
Detalhes completos

Investigações a serem consideradas

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

Algoritmo de tratamento

AGUDA

pituitary apoplexy

CONTÍNUA

microadenoma

macroadenoma without mass effect and not abutting optic chiasm

macroadenoma without mass effect but abutting optic chiasm

macroadenoma with mass effect

Colaboradores

Autores

Susmeeta Tewari Sharma, MD, MBBS, MHSc

Director of Pituitary Endocrinology

MedStar Washington Hospital Center/Georgetown University Hospital

Washington

DC

Declarações

STS declares that she has no competing interests.

Agradecimentos

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.

Revisores

S. Bulent Omay, MD

Assistant Professor of Neurosurgery

Yale Medical School

New Haven

CT

Declarações

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

Declarações

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

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.
  • 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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