Pituitary Adenoma Diagnosis and Management

Clinical Presentation

The Endocrine Society recommends assessing symptoms of hormone excess or deficiency, mass effect, and genetic predisposition in patients with pituitary adenoma, as these directly impact patient morbidity and mortality 1
Delayed or arrested puberty, growth failure or short stature, primary amenorrhea or menstrual disturbances in girls, galactorrhea, and secondary amenorrhea in post-menarcheal girls are common symptoms of prolactinomas 1
Rapid growth velocity in children and features of acromegaly in adults are associated with growth hormone-secreting adenomas 1
Weight gain, obesity, and features of hypercortisolism are associated with ACTH-secreting adenomas 1
Headaches, visual disturbances, symptoms of raised intracranial pressure, cranial nerve palsies, and hypothalamic dysfunction are common mass effect symptoms 2

The American Association of Clinical Endocrinologists recommends asking about family history of pituitary adenomas, multiple endocrine neoplasia (MEN1), familial isolated pituitary adenoma (FIPA), and other endocrine tumors 4
Genetic testing should be considered in all children and young people with pituitary adenoma, particularly for GH and prolactin-secreting tumors due to high prevalence of genetic abnormalities 4

A single prolactin measurement at any time of day is recommended for suspected prolactinoma, with consideration of serial measurements for modestly elevated prolactin levels 1
MRI with pre-contrast and post-contrast enhanced thin-sliced sequences is recommended for imaging 7
Visual acuity, visual fields, and fundoscopy should be assessed, with consideration of optical coherence tomography for baseline assessment 3

Growth patterns and pubertal development should be assessed in pediatric patients, with consideration of school performance and timing of symptoms in relation to expected developmental milestones 1, 6
Mass effects are more common at presentation in children than in adults 2
Developmental delays may be associated with certain genetic syndromes 4, 5
The Endocrine Society recommends considering genetic testing even without family history due to potential for de novo mutations 1, 4, 5