From the Guidelines
Pituitary adenomas can present with various signs and symptoms, including headaches, vision problems, fatigue, and nausea, and may secrete excess hormones leading to specific syndromes such as prolactin-secreting tumors causing irregular menstruation, or growth hormone-secreting tumors leading to acromegaly, as noted in recent guidelines 1.
Common Signs and Symptoms
- Headaches
- Vision problems (particularly peripheral vision loss or double vision)
- Fatigue
- Nausea
- Irregular menstruation in women
- Breast milk production in non-pregnant women
- Decreased libido
- Enlarged hands, feet, and facial features (acromegaly)
- Weight gain, muscle weakness, and easy bruising (Cushing's disease)
- Hyperthyroidism symptoms like weight loss and anxiety (TSH-secreting tumors)
Diagnosis and Treatment
Diagnosis typically involves blood tests to measure hormone levels, MRI imaging of the brain, and visual field testing, as recommended in the consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence 1. Treatment options include medication (particularly for prolactin-secreting tumors), surgery, radiation therapy, or a combination approach, depending on tumor type, size, and individual patient factors, with a strong recommendation for multidisciplinary assessment and care, including systematic pituitary hormone assessment, access to age-appropriate expert neuroimaging, visual review, histopathology, informed genetic assessment, and evaluation by an expert pituitary surgeon working closely with the paediatric endocrinology, neuro-oncology, and radiotherapy teams 1.
Specific Considerations
- GH excess is supported by an elevated serum IGF1 level in relation to the age-adjusted, sex-adjusted, and Tanner stage-matched normal range, with a strong recommendation for dynamic pituitary assessment of possible hypofunction and hyperfunction of other anterior pituitary hormones in CYP with GH excess 1.
- Pituitary adenomas can be associated with syndromic diseases, and clinical evaluation for associated syndromic causes of somatotrophinomas should be offered to CYP with GH excess, with a strong recommendation for biochemical screening for pituitary hormone excess to all CYP with Carney complex, McCune–Albright syndrome, and patients with MEN1 or MEN1-like disease 1.
From the Research
Signs and Symptoms of Pituitary Adenoma
The signs and symptoms of pituitary adenoma can vary depending on the type of tumor and its size. Some common symptoms include:
- Headache
- Visual field defects
- Hypopituitarism
- Infertility
- Galactorrhea (spontaneous flow of milk from the breast)
- Loss of libido
- Erectile dysfunction
- Acromegaly (enlargement of the hands, feet, and face)
- Cushing's disease (obesity, hypertension, diabetes, and other morbidity)
Hormone-Secreting Tumors
Pituitary adenomas can secrete excess hormones, leading to various clinical syndromes, such as:
- Hyperprolactinemia (elevated prolactin levels) 2, 3, 4
- Acromegaly (excess growth hormone) 2, 5
- Cushing's disease (excess adrenocorticotropic hormone) 2, 5
- Hyperthyroidism (excess thyroid-stimulating hormone) 2
Mass Effects
Large pituitary adenomas can cause mass effects, such as:
- Compression of the optic chiasm, leading to visual field defects 2, 5
- Hypopituitarism (deficiency of one or more pituitary hormones) 2, 5, 3
Diagnosis and Treatment
Diagnosis of pituitary adenoma typically involves imaging studies, such as MRI, and endocrine evaluation for hormone hypersecretion 2, 5, 3. Treatment options depend on the type and size of the tumor, and may include: