Pituitary Adenoma

• Hypo or hyper pituitarism

  • Increased prolacin

    • Amenorrhgea, galactorrhea, and impotence

    • This may also be seen with hepatic, renal, phenothiazines, verapamil, cimetidine, and pregnancy

  • Increased adrenocorticotropic hormone

    • Increased serum and urine cortisol

    • hyperpigmentation

    • hypertension

    • hyperglycemia

    • abdominal stria

    • moon face

    • truncal obesity

    • extremity wasting

    • bruising

    • osteoporosis

    • amenorrhea

    • peripheral neuropathy

    • depression

  • Decreased ACTH

    • orthostatic hypotension and fatigue

  • Increased GH

    • Increased somatomedin C

    • Acromegaly

    • perripheral neuropathy

    • cardiomyopathy

    • hyperrtension

    • glusoce intolerace

    • colon cancer

  • Decreased GH release

    • dwarfism

  • decreased TSH

    • cold intolerance, fatigue, coarse hair, peripheral neuropathy, myxedema coma

  • decreased FSH/LH

    • amenorrhea, decreased libido, infertility

  • decreased antiduretic hormone

    • diabetes insipidus

• Evaluation

  • Endocrine history (above)

  • Prolactin (25-150 is from stalk effect from decreased dopamine that normally inhibits prolactin)

  • Morning cortisol

  • ACTH

  • Decadron suppression test

    • low dose of 1mg- normally decreased ACTH

    • high dose of 8mg decreased ACTH with cushing disease

    • There is no suppression with an ectopic tumor

  • TSH, T4,GH, somatomedin c, FSH/LH/ estrogen, testosterone

  • MRI

    • Enlarged pituitary can be seen with pregnancy and hypothyroidism (TSH elevation)

• Treatment

  • Prolactinoma

    • Bromocriptine 75% tumor reduction in 8 weeks

    • Lifelong therapy needed to control tumor growth

      • 2.5 mg BID

      • emesis and postural hypotension which resolves over several weeks

      • monitor for low estrogen

    • Patient can be followed with visual field examinations

    • Dostinex is another medical option

    • Consider transsphenoidal or subfrontal resection if medical therapy fails

  • Acromegaly

    • Surgical resection best option

    • Medical therapy exists, but is expensive.

    • IGF-1 levels from 4 weeks after surgery

  • Cushing disease

    • Surgical resection if the best option

    • ketoconazole may be used to temporarily lower cortisol levels

    • bilateral adrenalectomy last resort

  • Hyperthyroidism

    • Surgical resection favored over octreotide

  • Radiation

    • 50 Gy over 6 weeks

    • 50% decreased in ACTH, FSH/LH, and TSH in 10 years

    • Visual loss may occur

    • Only if unable to operate

• Complications

  • DI

  • CSF leak

  • Carotid injury