From the Guidelines
Pituitary mass follow-up laboratory tests should include systematic pituitary hormone assessment.
Indicated Tests
- Thyroid function tests: TSH, free T4 1
- Adrenal function tests: ACTH, cortisol or 1 mcg cosyntropin stimulation test 1
- Gonadal hormones: testosterone in men, estradiol in women, FSH, LH 1
- GH excess testing: for patients with excess height or acromegalic features, with or without delayed or arrested puberty or family history of pituitary adenoma 1
Additional Evaluations
- MRI brain with pituitary or sellar cuts: for all patients with new hormonal deficiencies, multiple endocrine abnormalities, severe headaches, or complaints of vision changes 1
- Genetic assessment: for all patients with a pituitary adenoma to inform management and family surveillance, particularly for those with GH and prolactin excess 1
- Visual review: as part of a multidisciplinary assessment and care approach 1
- Histopathology: as part of a multidisciplinary assessment and care approach 1
From the Research
Laboratory Tests for Pituitary Mass Follow-up
The following laboratory tests are indicated for the follow-up of a pituitary (hypophyseal) mass:
- Serum prolactin levels for small tumors 2
- Laboratory evaluation for metabolic problems if present 2
- Assessment for hypopituitarism, clinically and biochemically, if the mass is large 2
- Insulin-like growth factor 1 levels and growth hormone levels for growth hormone-secreting tumors 3
- Late-night salivary cortisol level as a screening test for adrenocorticotropic hormone (ACTH)-secreting tumors 3
- Petrosal sinus sampling for ACTH to distinguish a pituitary from an ectopic source 3
- Thyroid-stimulating hormone levels for thyroid-stimulating hormone-secreting tumors 3, 4
Additional Evaluations
Additional evaluations that may be necessary for the follow-up of a pituitary mass include:
- Detailed history and physical examination to look for signs of functional or 'subclinically' functional tumor 2
- Enhanced MRI if the mass was discovered on a computed tomography scan 2
- Ophthalmological examination, including formal visual field testing, if the mass is compressing the optic chiasm 5, 2, 6
- Assessment of hypothalamic-pituitary hormonal function 6