|
Factsheet 15 Diagnosis of pituitary disease is not straightforward. There are a wide range of symptoms, reflecting the various conditions caused by a Pituitary tumour. Some are specific and obvious but many are vague and may not point to the pituitary. Most GPs see only one or two cases in their whole careers which compounds the problem. The tables following list symptoms associated with various tumour types: more details are included in the specific sheets. Whilst you would not want to send every patient with a headache to an Endocrinologist, those with high circulating th yroxine and high TSH should be referred. To this end a list of basic tests is also included. For Acromegaly & Prolactinoma especially, there should be a low threshold for referral for any patient with any suspicion of these conditions as the greatest challenge in their diagnosis is thinking of the disease. Once suspected biochemical confirmation or exclusion of the disease is usually straightforward. WHO SHOULD YOU REFER TO?
Ideally to a specialist endocrinologist or a local physician with a special interest in endocrinology. It is better to see an endocrinologist first rather than a surgeon as the surgeon will need to refer the patient to an endocrinologist in any case. In some cases surgery is not recommended. The endocrinologist can arrange all the specialist diagnostic tests to be completed prior to surgery enabling accurate monitoring of treatment to take place. LIFE-LONG RELATIONSHIP
Life-long specialist monitoring will be required after initial treatment to ensure the appropriate and optimum balance of hormones is achieved. Many patients will be on life-long hormone replacement. In most cases a shared care protocol is established between the specialist and the patient’s GP. PRESENTING SYMPTOMS
These are the main symptoms; see individual sheets for additional information. Main symptoms common to various tumour types | Associated with: | Visual disturbance | Non-functioning (NF), acromegaly, Hyperprolactinaemia, Craniopharyngioma | Oligomenorrhoea or Amenorrhoea | NF, hyperprolactinaemia, Hypogonadism | Reduced libido in men & women, and reduced potency in men | NF, hyperprolactinaemia, hypogonadism | Headache | NF, acromegaly, hyperprolactinaemia, craniopharyngioma | | Tiredness and lack of energy | NF, acromegaly, hypopituitarism (especially loss of GH and/or TSH and/or ACTH) |
| Main symptoms specific to one or two types of tumour | | Coarsening of facial features | Acromegaly | | Enlarged hands and feet, growth of the jaw | Acromegaly | | Carpal Tunnel Syndrome | Acromegaly | | Excessive sweating and oily skin | Acromegaly | | Sleep apnoea | Acromegaly | | Moon face - particularly filling in of the temporal fossa | Cushing’s | | Weight gain - central obesity | Cushing’s | Muscle wasting and proximal myopathy (patients have
difficulty standing from a seated position without use
of arms) | Cushing’s | | Thin skin - tendency to bruise | Cushing’s | | Hirsutism (caused by androgen excess) | Cushing’s | | Violaceous striae | Cushing’s | | Hypertension | Acromegaly, Cushing’s | | Diabetes | Acromegaly, Cushing’s | | Osteoporosis and fractures | Cushing’s | | Psychiatric disturbance (often characterised by amplification of previous personality traits) | Cushing’s | | Galactorrhoea | Hyperprolactinaemia | | Growth retardation in children | Any pituitary tumour causing
hypopituitarism and Growth hormone
Deficiency (GHD), craniopharyngioma | | In adults: excessive tiredness, muscle weakness, lack of drive, impaired quality of life | Hypopituitarism - GH deficiency | | Tired, difficulty recovering from minor illness | Hypopituitarism - (ACTH, Cortisol deficiency), craniopharyngioma | | Weight gain, decreased energy, sensitivity to cold, constipation, dry skin | Hypopituitarism - TSH deficiency | | Pale appearance, weight loss, low blood pressure, dizziness, tiredness, ‘collapse’ during intercurrent illness | Hypopituitarism " ACTH deficiency | | Thirst, polydipsia, polyuria and nocturia | Hypopituitarism - AVP deficiency - Diabetes Insipidus, craniopharyngioma | | Delayed or arrested puberty, and very occasionally precocious puberty | Craniopharyngioma | | Dyspareunia and hot flushes in women | Hypogonadism | Absence of or incomplete sexual development:
- lack of genital enlargement deficiency
- lack of pubic/ axillary hair and beard growth
- lack of muscle development
- lack of sexual interest
- failure of the voice to break.
- spermatogenesis will not be initiated and infertility is
the general rule | Pre-pubertal onset of Testosterone " male hypogonadism | Poorly maintained established secondary sexual characteristics: deficiency
- tiredness
- reduced libido and sexual functioning
- reduced body and facial hair and muscle mass,
infertility | Post-pubertal onset of testosterone " male hypogonadism |
©2011 Version 3 (To be reviewed by 2013) 
|
