Causes of Pituitary Masses
Evaluation of a Pituitary Incidentaloma
Management of Pituitary Neoplasia
Abnormal Anterior Pituitary Function Associated with Pituitary Masses
Hyperprolactinemia and Prolactinomas

Etiology of Pituitary-Hypothalamic Lesions
Non-Functioning Pituitary Adenomas
Endocrine active pituitary adenomas
Prolactinoma
Somatotropinoma
Corticotropinoma
Thyrotropinoma
Other mixed endocrine active adenomas
Malignant pituitary tumors: Functional and non-functional pituitary carcinoma
Metastases in the pituitary (breast, lung, stomach, kidney)
Pituitary cysts: Rathke's cleft cyst, Mucocoeles, Others
Empty sella syndrome
Developmental abnormalities: Craniopharyngioma (occasionally intrasellar location), Germinoma, Others
Primary Tumors of the central nervous system: Perisellar meningioma, Optic glioma, Others
Vascular tumors: Hemangioblastoma, Others
Malignant systemic diseases: Hodgkin's disease, Non-Hodgkin lymphoma, Leukemic infiltration, Histiocystosis X, Eosinophilic granuloma, Giant cell granuloma (tumor)
Granulomatous diseases: Neurosarcoidosis, Wegner's granulomatosis, Tuberculosis, Syphilis
Vascular aneurysms (intrasellar location)

Radiologic Evaluation: MRI
Preferred imaging study for the pituitary
Better visualization of soft tissues and vascular structures than CT
No exposure to ionizing radiation
Images are generated based upon the magnetic properties of the hydrogen atoms
T1-weighted images produce high–signal intensity images of fat. Structures such as fatty marrow and orbital fat show up as bright images.
T2-weighted images produce high-intensity signals of structures with high water content, such as cerebrospinal fluid and cystic lesions

Radiologic Evaluation: CT
Better at visualizing bony structures and calcifications within soft tissues
Better at determining diagnosis of tumors with calcification, such as germinomas, craniopharyngiomas, and meningiomas
May be useful when MRI is contraindicated, such as in patients with pacemakers or metallic implants in the brain or eyes
Disadvantages include:
less optimal soft tissue imaging compared to MRI
use of intravenous contrast media
exposure to radiation

Clinical Evaluation
All patients with macroadenomas should have formal visual field testing
In addition to radiographic and hormonal evaluation, patients should be asked and examined for any clinical signs suspicious for pituitary hyperfunction or hypofunction.

Hormonal Evaluation
May include of both basal hormone measurement and dynamic stimulation testing.

All pituitary masses should have screening basal hormone measurements, including:
Prolactin
TSH, FT4
ACTH, AM cortisol, midnight salivary cortisol
LH, FSH, estradiol or testosterone
Insulin-like growth factor-1 (IGF-1)

Dynamic stimulation/suppression testing may be useful in select cases to further evaluate pituitary reserve and/or for pituitary hyperfunction
  • Dexamethasone suppression testing
  • Oral glucose GH suppression test
  • GHRH, L-dopa, arginine
  • CRH stimulation
  • Metyrapone
  • TRH stimulation
  • GnRH stimulation
  • Insulin-induced hypoglycemia


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