CAUSE

 Benign pituitary adenoma – headaches, visual impairment (optic chiasm compression),

impaired CN III, IV and VI (cavernous sinus involvement)
 Inherited multiple endocrine neoplasia type 1 (MEN 1)

SIGNS AND SYMPTOMS

1. PL
 Children – headaches, visual disturbance, growth failure
 Pubertal females – hypogonadism (± galactorrhoea) due to suppression of GnRH secretion or
local pituitary compression
 Pubertal males – headaches, visual impairment and growth failure

2. ACTH
 Children – weight gain, growth failure
 Prepubertal – hirsutism and premature adrenarche.
 Pubertal arrest, acne, fatigue, depression, hypertension

3. GH
 Gigantism in children – longitudinal growth acceleration
 Acromegaly in adults

4. TSH
 Hyperthyroidism

5. LSH/FH
 Abnormal menstrual cycle
 Defect in ovogenesis and spermatogenesis

6. ADH
 Hypervolemia, hyponatremia
 SIADH

DIAGNOSIS

1. Prolactemia – prolactin levels

2. Acromegaly – GH levels, oral glucose tolerance test
 Healthy people experience drop in GH levels after glucose intake unlike acromegaly
3. Cushing's syndrome – history of taking exogenous glucocorticoid, high dose dexamethasone
suppression test, sinus blood samples
 Cortisol should decrease in response to dexamethasone. If not, then ectopic.
4. MRI – size and location of tumour
TREATMENT

1. Surgery – trans-sphenoidal adenectomy

2. Drugs
a. Dopamine agonists (bromocriptine, cabergoline) – prolactinemia
b. Somatostatin analogues – acromegaly
3. Radiation
a. Conventional – small doses over a period of time. Can damage normal tissue surrounding the
tumour
b. Stereotactic therapy – one-time high dose radiation targeted at tumour resulting in less
damage to surrounding healthy tissue.
4. Hormone replacement