A pituitary adenoma is a benign tumor of the pituitary gland that can make too much of a hormone or press on nearby structures. Large tumors (over 1 cm) can compress the optic chiasm and cause loss of outer vision, while many small ones are found by chance on brain imaging.
Key symptoms
- Headache
- Loss of side vision or bumping into things
- Signs of hormone excess: nipple discharge, changing features, weight gain
- Signs of hormone loss: fatigue, low libido, missed periods
- Sudden severe headache with vision change (apoplexy)
What you find on exam
- Visual fields by confrontation: bitemporal hemianopia
- Eye movements (cranial nerves III, IV and VI)
- Signs of acromegaly or Cushing
- Galactorrhea, breast tissue in men or small testes
- Blood pressure and signs of low cortisol
Tests
- Pituitary MRI with contrast
- Prolactin, IGF-1 and cortisol screening for hormone excess
- TSH with free T4, LH, FSH, testosterone or estradiol and morning cortisol
- Formal visual field testing
Treatment basics
- Prolactinoma: cabergoline is first line
- Most other hormone-making or large tumors: transsphenoidal surgery
- Replace missing hormones, cortisol before thyroid
- Radiation for leftover or regrowing tumor
- Small nonfunctioning tumors: monitor with MRI
Red flags
- Sudden thunderclap headache with vision loss or double vision
- Low blood pressure and low sodium (adrenal crisis)
- Rapid loss of vision
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.