Pituitary incidentalomas Flashcards
If there is an incidental pituitary incidentaloma that is <10 mm what do you do?
look for clinical features of pituitary hyperfunciton
evaluate if there’s pituitary hypofunction and visual field testing not needed.
If absent, prolactin level is checked
if present, check targeted hormone testing
If there is an incidental pituitary incidentaloma that is >10 mm what do you do?
Check for pituitary hyperfunction and hypofunction and visual field testing.
Surgery if positive (except in prolactinoma)
Conservative treatment if negative.
when do we get surgery for incidental pituitary adenoma?
Surgery for enlarging mass or pituitary hormone dysfunction on follow up.
What if you find a pituitary adenoma that is 5-9 mm on random imaging? what do you do?
repeat MRI of brain in 12 months to document lack of growth
What if you find a pituitary incidentaloma that is 2-4 mm
no further testing.
Incidence of pituitary adenoma?
10% of ppl have one
generally most pituitary masses do not grow rapidly over time.
physiological causes of hyperprolactinoma
pregnancy, breast feeding and stress
pathological causes of hyperprolactinoma
pituitary adenoma (prolactinomas), hypothalamic dx with decrease dopamine (malignancy, sarcoidosis), drugs (antipsychotics, and metoclopramide) and hypothyroidism, chest wall injury, (herpes, burns), CKD and after generalized tonic clonic or focal seizure
Prolactin levels are high in pregnancy because
of high estrogen levels and peak at delivery and normalize within 1-2 months after delivery even with continued breast feeding.
presentation of prolactinomas?
bilateral milky nipple discharge (galactorrhea) and hypogonadism
Elevated prolactin that is pathological
> 200 ng/ml
Next step for anyone with suspected prolactinoma would be
MRI of head to screen for pituitary mass.
Also may need a formal visual exam
