Common presentation: a premenopausal woman with amenorrhea, headache, and vision changes (bitemporal hemianopsia).
Diagnostic testing
-MRI of the brain.
Background
“Pituitary adenomas are the most common disorder of the pituitary gland and are responsible for 10%–15% of all intracranial masses. They present with symptoms of hormone secretion or a neurologic mass effect, or as an incidental finding on CT/MRI. Premenopausal women often experience amenorrhea, while the most common neurologic symptoms are headache and vision changes (classically bitemporal hemianopsia) due to compression of the optic chiasm. Tumors secreting prolactin (lactotrophs) are the most common, comprising 40%–57% of all pituitary adenomas. Nonsecreting tumors make up 28%–37%, growth hormone-secreting adenomas (somatotrophs) 11%–13%, and ACTH-secreting adenomas (corticotrophs) 1%–2%. FSH-, LH-, and TSH-secreting tumors are rare. ACTH-secreting tumors result in an increase in circulating cortisol, and the diagnosis is confirmed by 24-hour urine cortisol, late-night salivary cortisol, or overnight dexamethasone suppression testing. Gonadotrophs cause a resulting elevation of FSH and LH. Lactotrophs increase serum prolactin, and somatotrophs increase serum insulin-like growth factor. Thyrotrophs result in normal TSH with low free T4.” ABFM critique.
Panhypopituitary 2/2 to pituitary macroadenoma. S/p resection.
Further Reading
Pituitary adenomas: An overview. Am Fam Physician 2013;88(5):319-327.
Incidentalomas: Initial management. Am Fam Physician 2014;90(11):784-789.