Clinical correlate 10 Pituitary Problems

Study questions

1. What kinds of pituitary tumors are there?

2. Review the hormonal effects of pituitary tumors: which are due to mass effect, undersecretion, and oversecretion?

3. What prolactin level suggests the presence of a prolactinoma?

4. When and how often are MRI’s indicated to diagnose and follow pituitary adenomas? Answer your question in the light of the effects of tumor size and rate of growth.

Reference Texts

A. http://www.aafp.org/afp/20040801/543.html

Diagnosis and Management of Galactorrhea Leung A KC, Picaud D.

After infancy, galactorrhea usually is medication-induced. The most common pathologic cause of galactorrhea is a pituitary tumor. Other causes include hypothalamic and pituitary stalk lesions, neurogenic stimulation, thyroid disorders, and chronic renal failure. Patients with the latter conditions may have irregular menses, infertility, and osteopenia or osteoporosis if they have associated hyperprolactinemia. Tests for pregnancy, serum prolactin level and serum thyroid-stimulating hormone level, and magnetic resonance imaging are important diagnostic tools that should be employed when clinically indicated. The underlying cause of galactorrhea should be treated when possible. The decision to treat patients with galactorrhea is based on the serum prolactin level, the severity of galactorrhea, and the patient's fertility desires. Dopamine agonists are the treatment of choice in most patients with hyperprolactinemic disorders. Bromocriptine is the preferred agent for treatment of hyperprolactin-induced anovulatory infertility. Although cabergoline is more effective and better tolerated than bromocriptine, it is more expensive, and treatment must be discontinued one month before conception is attempted. Surgical resection rarely is required for prolactinomas. (Am Fam Physician 2004;70:543-50,553-4. Copyright© 2004 American Academy of Family Physicians.)

B. http://www.clevelandclinicmeded.com/diseasemanagement/endocrinology/pituitary/pituitary.htm

Hypopituitarism is often progressive. Although the signs and symptoms can occur suddenly, usually they tend to develop gradually. They're sometimes vague and subtle, and may be overlooked for many months or even years.

Signs and symptoms of hypopituitarism vary, depending on which pituitary hormones are deficient. The signs and symptoms may include:

* Fatigue

* A decline in energy

* Muscle weakness

* Nausea

* Constipation

* Weight loss or gain

* A decline in appetite

* Abdominal discomfort

* Sensitivity to cold or difficulty staying warm

* Visual disturbances

* Loss of underarm and pubic hair

* Joint stiffness

* Hoarseness

* Facial puffiness

* Thirst and excess urination

* Low blood pressure

* Headaches

If you're a man, you may also have signs and symptoms such as:

* Loss of interest in sexual activity

* Erectile dysfunction

* Decrease in facial or body hair

If you're a woman, you may develop:

* Irregular or stopped menstrual periods

* Infertility

* Inability to produce milk for breast-feeding

Children may experience stunted growth, short stature and slowed sexual development.