D.F. Malan St, Cape Town City Centre, Cape Town, 8000, South Africa

©2017 BY CAPE TOWN PITUITARY COLLABORATIVE.

HEALTHCARE PROFESSIONALS

At the Cape Town Pituitary Collaborative we welcome partnerships with our patients care-givers. Our commitment is to keep the patient's medical teams involved and appraised of their condition and treatments. Please reach out to members of of the team should you wish to discuss medical issues.

 

PITUITARY DISORDERS: A HEALTHCARE PROVIDER'S GUIDE

Etiology

Benign pituitary adenomas most often cause pituitary disease. These are classified as either functioning (overproducing one or more hormones) or non-functioning. The incidence of these tumours is 35 cases per million. 


Signs & Symptoms

Diagnosis of pituitary disease can be challenging, besides the low incidence of disease, many of the presenting symptoms are diverse. 


Consider the following questions when contemplating pituitary disease in a patient:

  • Are there signs or symptoms of deficiencies or excess in pituitary hormones? 

  • Are there signs or symptoms of a space-occupying pituitary lesion? Clinical manifestations include headaches, visual problems (especially peripheral vision loss) and occasionally seizures or cranial nerve deficits.

Deficiency Disorder Symptoms include:

ACTH-Adrenal Insufficiency: abdominal discomfort, joint aches

TSH-Hypothyroidism: constipation, cold intolerance, proximal muscle weakness, dry skin, memory loss, hair loss

LH/FSH-Hypogonadism: sexual dysfunction, hot flashes, menstrual irregularity

GH-Adult growth hormone deficiency: lack of vigor, decreased exercise tolerance, feelings of social isolation

ADH-Diabetes insipidus: polydipsia, polyuria, nocturia


Excess Disorder Symptoms include:

Prolactin-Hyperprolactinemia: galactorrhea, sexual dysfunction

ACTH/Cortisol-Cushing's Disease: moon facies, truncal obesity, purple stria, hirsutism, hypertension, diabetes mellitus, proximal muscle weakness

GH-Acromegaly: enlarged hands/feet/jaw, carpal tunnel syndrome, oily skin, joint pain


Initial Workup

MRI brain imaging should be performed if either the laboratory evaluation indicates the presence of pituitary disease or if a space-occupying lesion is suspected. 


The Basic Pituitary Disease/Pituitary Tumor Work-up

Hormones to check:

  • Prolactin

  • 8:00 a.m. serum cortisol and ACTH stimulation test

  • TSH and Free T4

  • LH and FSH

  • Testosterone (men)

  • IGF-1 (Insulin-like Growth Factor-1)

  • 24 hour Urine Free Cortisol (for Cushing’s)

Imaging (if indicated)

  • Head MR imaging (with and without gadolinium)


If the work-up indicates the presence of a pituitary tumor or disease, the condition is usually best managed by a multi-disciplinary team.


Treatment typically includes a combination of medication and surgery and may involve irradiation.


The majority of non-prolactin secreting tumors will likely require surgery. 

Treatment

The most common surgical approach for the resection of pituitary tumors is through the sphenoid sinus (trans-sphenoidal).


Surgical outcome studies have repeatedly shown that surgeons highly experienced in this procedure obtain the highest cure rates with the lowest rates of recurrence, post-operative complications and pituitary dysfunction.