Type of tumour | |||||
---|---|---|---|---|---|
Evaulation | Prolactin secreting adenoma | GH-secreting adenoma | ACTH secreting adenoma | Other (rare) TSHoma, FSHoma | Non-functioning adenoma |
Common clinical features | Galactorrhoea Oligo/amenorrhoea in women Infertility Erectile dysfunction in men Gynaecomastia | Coarse facial features Enlargement of jaw, hands and feet Deepening of voice Macroglossia Sleep apnoea Insulin resistance and diabetes | Round plethoric face, excess acne Rapid weight gain, truncal obesity, buffalo hump, supraclavicular fat pads, violaceous striae Easy bruising Proximal myopathy Hypertension Impaired glucose regulation and diabetes | TSHoma: symptoms suggestive of hyperthyroidism: heat intolerance, weight loss, irritability, anxiety, palpitations, tremors, diarrhoea FHSoma: rarely results in a clinical syndrome; can cause macro-orchidism | Can be associated with hypopituitarism Cortisol deficiency: lethargy, vomiting, hypotension, hyponatraemia, hyperkalaemia Thyroid hormone deficiency: as in hypothyroidism FSH/LH deficiency: oligo/amenorrhoea, infertility, reduced libido and erectile dysfunction in men GH deficiency: reduced energy level, bone mineral density and lean body mass |
Expected abnormalities on baseline pituitary profile | Raised prolactin | Raised GH and IGF1 | Loss of cortisol diurnal rhythm. Random cortisol might be normal or raised | Raised FT4 and FT3 and inappropriately normal or raised TSH | If hypopituitarism is present, any of the hormones (cortisol/TSH/FT4/FSH/LH/testosterone/GH/IGF1) could be low Prolactin might be mildly elevated because of pituitary stalk compression |
Specialist dynamic pituitary tests to assess pituitary hormone production | Not required | Glucose tolerance test (OGTT) with GH levels | Dexamethasone suppression tests 24-h urinary free cortisol excretion Late-night salivary cortisol | Thyrotropin-releasing hormone (TRH) test | Insulin tolerance test (ITT) or glucagon stimulation test to assess cortisol and growth hormone deficiency Short Synacthen® test also used to assess for cortisol deficiency |
ACTH = adrenocorticotropic hormone; FSH = follicle-stimulating hormone; FT3 = free triiodothyronine; FT4 = free thyroxine; GH = growth hormone; LH = luteinising hormone; IGF1 = insulin-like growth factor 1; ITT = insulin tolerance test; OGTT = oral glucose tolerance test; TSH = thyroid-stimulating hormone.