Diagnostic process in which pituitary gland tumors and hormone disorders (prolactinoma, acromegaly, Cushing disease, hypopituitarism) are assessed through endocrinological tests and imaging.
Indication
- Recurrent headaches and visual field loss (especially tunnel vision)
- Menstrual irregularity and milk discharge (galactorrhea) in women; reduced libido in men
- Enlargement of the hands, feet, and facial features (suspected acromegaly)
- Unexplained weight gain, moon face, purple stretch marks (suspected Cushing disease)
- Unexplained fatigue, low blood pressure, cold intolerance (suspected hypopituitarism)
- Pituitary adenoma detected incidentally on brain imaging
- Short stature in children, or precocious or delayed puberty
Preparation
- The patient should arrive fasting in the morning; some hormone tests are taken at specific times
- Stress, irregular sleep, and intense exercise are limited before the test
- Medications such as estrogens, dopamine agonists, and corticosteroids may be adjusted with physician approval
- Previous MRI, CT, and hormone test results are brought along
- An ophthalmology report may be requested if there is visual disturbance
How it's performed
- A detailed history and systemic physical examination are performed
- Pituitary hormones such as prolactin, IGF-1, ACTH, cortisol, TSH, fT4, FSH, LH, testosterone/estradiol are measured
- Dynamic tests are applied based on suspicion: oral glucose tolerance test (for acromegaly), 1 mg dexamethasone suppression test (for Cushing), insulin tolerance test (for growth hormone deficiency)
- The pituitary gland is examined in detail using contrast-enhanced magnetic resonance imaging (MRI)
- A visual field test and, if needed, fundus examination are scheduled
- Based on the findings, options of medical therapy, surgery, or radiotherapy are evaluated by a multidisciplinary council
Post-procedure
- Hormonal and radiological follow-up every 6-12 months for microadenomas
- In patients on treatment, drug dose, side effects, and hormonal response are monitored
- After surgery, follow-up every three months in the first year, then every 6-12 months
- Continuity of hormone replacement is monitored in patients who develop pituitary insufficiency
- Visual field and neurological findings are periodically reassessed
Risks
- Temporary dizziness, nausea, or hypoglycemia during testing (insulin tolerance test)
- Rare allergic reaction during contrast-enhanced MRI
- Unnecessary further investigation due to a misinterpreted single hormone value
- When surgical treatment is required, risks specific to pituitary surgery (bleeding, CSF leak, permanent hormone deficiency)
- Visual loss or permanent hormonal disturbance if diagnosis is delayed
FAQ
Does every pituitary adenoma need surgery?
No. Small, non-secreting adenomas without compression of the visual pathways are usually followed up. In prolactinoma, medical therapy is the first-line treatment; surgery is planned for selected cases.
Are pituitary disorders hereditary?
Most pituitary adenomas develop sporadically. However, familial predisposition can be seen in rare genetic syndromes such as MEN-1, in which genetic counseling is recommended.
How long does it take for results to be ready after MRI?
The radiology report is usually prepared within a few days after imaging. The diagnosis is finalized after evaluation together with the hormone test results.
Does hormone treatment last for life?
If pituitary insufficiency is permanent, replacement therapy may continue for life. In temporary deficiencies caused by tumors, the dose and duration of treatment are reassessed.
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