Diagnosis and Treatment of Pituitary Adenomas

Molitch, Mark E.

doi:10.1001/jama.2016.19699

Cited by 814 publications

(700 citation statements)

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“…Prolactin is normally inhibited by the neurotransmitter dopamine coming from the hypothalamus, so that hypothalamic or pituitary stalk disease may cause a decrease in this inhibition and a rise in prolactin levels [3]. Many medications that block dopamine receptors can also cause prolactin elevations [1].…”

Section: Discussionmentioning

confidence: 99%

“…In man, elevated prolactin levels suppress the hypothalamic-pituitary-gonadal axis, resulting in hypogonadism, which may include low testosterone levels leading to erectile dysfunction, decreased libido, and impotence which can be quite distressing for the patient [3]. Studies on bone loss have generally focused on postmenopausal women or hyperparathyroidism [6].…”

Section: Discussionmentioning

confidence: 99%

“…MRI will determine whether a tumor is present and its size. More than 90% of prolactinomas are microadenomas [3]. Normal prolactin levels in men are below 20 ng/dl [2].…”

Section: Discussionmentioning

confidence: 99%

“…If the tumor is very large, the very high prolactin levels may rarely saturate the antibodies in some assays, leading to artificially low or normal results (hook effect). In this case, prolactin levels should be rerun at 1:100 dilution to exclude this [3]. The pathogenesis of most pituitary adenomas remains unknown, therefore, genetic evaluation is not warranted for patients presented with adenomas unless there is a compatible family history [3].…”

Section: Discussionmentioning

confidence: 99%

“…Prolactinomas are almost always benign; malignant tumors are extremely rare. Prolactinomas are generally classified according to size as microadenomas (less than 10 mm in diameter), macroadenomas (more than 10 mm in diameter) and giant adenomas (more than 40 mm) [2,3]. Signs and symptoms are erectile dysfunction, galactorrhea, persistent headache, dizziness, and even vision loss, but not all patients with pituitary tumors develop these symptoms because most tumors remain small and most do not secrete hormones in excessive amounts [2,3].…”

Section: Introductionmentioning

confidence: 99%

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Prolactinoma with galactorrhea and dysfunction erectile in man, a case report

Hendarto¹

2017

Proceedings of the 1st International Integrative Conference on Health, Life and Social Sciences (ICHLaS 2017)

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Abstract-Prolactinoma, is the most common type of pituitary adenoma. Signs and symptoms are due to either the effect of excess hormone secretion or local compression. Here we report a male patient with prolactinoma presented with high prolactin level, severe headache, diffuse arthralgias, visual field impairment, erectile dysfunction, and galactorrhea. A 40-yearold married man was admitted to the hospital with severe headache, diffuse arthralgias, bitemporal hemianopsia, galactorrhoea, and erectile dysfunction. The pubic and axillary hairs appeared normal and the development of the external genital organs seemed normal. Endocrinological studies revealed hyperprolactinemia. The serum testosterone was low, while the thyroid hormone, growth hormone, and cortisol hormone levels were normal. An X-ray of his L spine was concerning for decreased bone mass. CT scan Pituitary with contrast showed a large macroprolactinoma mass. The diagnosis of prolactinoma was made, and because the patient has progressive vision loss, combination therapy of surgery, typically a transphenoidal resection of the tumor and medication with cabergoline 0.5 mg twice weekly, was suggested. Prolactinoma in patients can cause clinical symptoms as a result of mass effects and/or hyperprolactinaemia. Careful history and physical examinations should reveal the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…MRI will determine whether a tumor is present and its size. More than 90% of prolactinomas are microadenomas [3]. Normal prolactin levels in men are below 20 ng/dl [2].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prolactinoma with galactorrhea and dysfunction erectile in man, a case report

Hendarto¹

2017

Proceedings of the 1st International Integrative Conference on Health, Life and Social Sciences (ICHLaS 2017)

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Cushing Syndrome

Reincke

Fleseriu

2023

JAMA

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ImportanceCushing syndrome is defined as a prolonged increase in plasma cortisol levels that is not due to a physiological etiology. Although the most frequent cause of Cushing syndrome is exogenous steroid use, the estimated incidence of Cushing syndrome due to endogenous overproduction of cortisol ranges from 2 to 8 per million people annually. Cushing syndrome is associated with hyperglycemia, protein catabolism, immunosuppression, hypertension, weight gain, neurocognitive changes, and mood disorders.ObservationsCushing syndrome characteristically presents with skin changes such as facial plethora, easy bruising, and purple striae and with metabolic manifestations such as hyperglycemia, hypertension, and excess fat deposition in the face, back of the neck, and visceral organs. Cushing disease, in which corticotropin excess is produced by a benign pituitary tumor, occurs in approximately 60% to 70% of patients with Cushing syndrome due to endogenous cortisol production. Evaluation of patients with possible Cushing syndrome begins with ruling out exogenous steroid use. Screening for elevated cortisol is performed with a 24-hour urinary free cortisol test or late-night salivary cortisol test or by evaluating whether cortisol is suppressed the morning after an evening dexamethasone dose. Plasma corticotropin levels can help distinguish between adrenal causes of hypercortisolism (suppressed corticotropin) and corticotropin-dependent forms of hypercortisolism (midnormal to elevated corticotropin levels). Pituitary magnetic resonance imaging, bilateral inferior petrosal sinus sampling, and adrenal or whole-body imaging can help identify tumor sources of hypercortisolism. Management of Cushing syndrome begins with surgery to remove the source of excess endogenous cortisol production followed by medication that includes adrenal steroidogenesis inhibitors, pituitary-targeted drugs, or glucocorticoid receptor blockers. For patients not responsive to surgery and medication, radiation therapy and bilateral adrenalectomy may be appropriate.Conclusions and RelevanceThe incidence of Cushing syndrome due to endogenous overproduction of cortisol is 2 to 8 people per million annually. First-line therapy for Cushing syndrome due to endogenous overproduction of cortisol is surgery to remove the causative tumor. Many patients will require additional treatment with medications, radiation, or bilateral adrenalectomy.

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Diagnosis and Management of Pituitary Adenomas

Tritos

Miller

2023

JAMA

102

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ImportancePituitary adenomas are neoplasms of the pituitary adenohypophyseal cell lineage and include functioning tumors, characterized by the secretion of pituitary hormones, and nonfunctioning tumors. Clinically evident pituitary adenomas occur in approximately 1 in 1100 persons.ObservationsPituitary adenomas are classified as either macroadenomas (≥10 mm) (48% of tumors) or microadenomas (&lt;10 mm). Macroadenomas may cause mass effect, such as visual field defects, headache, and/or hypopituitarism, which occur in about 18% to 78%, 17% to 75%, and 34% to 89% of patients, respectively. Thirty percent of pituitary adenomas are nonfunctioning adenomas, which do not produce hormones. Functioning tumors are those that produce an excess of normally produced hormones and include prolactinomas, somatotropinomas, corticotropinomas, and thyrotropinomas, which produce prolactin, growth hormone, corticotropin, and thyrotropin, respectively. Approximately 53% of pituitary adenomas are prolactinomas, which can cause hypogonadism, infertility, and/or galactorrhea. Twelve percent are somatotropinomas, which cause acromegaly in adults and gigantism in children, and 4% are corticotropinomas, which secrete corticotropin autonomously, resulting in hypercortisolemia and Cushing disease. All patients with pituitary tumors require endocrine evaluation for hormone hypersecretion. Patients with macroadenomas additionally require evaluation for hypopituitarism, and patients with tumors compressing the optic chiasm should be referred to an ophthalmologist for formal visual field testing. For those requiring treatment, first-line therapy is usually transsphenoidal pituitary surgery, except for prolactinomas, for which medical therapy, either bromocriptine or cabergoline, is usually first line.Conclusions and RelevanceClinically manifest pituitary adenomas affect approximately 1 in 1100 people and can be complicated by syndromes of hormone excess as well as visual field defects and hypopituitarism from mass effect in larger tumors. First-line therapy for prolactinomas consists of bromocriptine or cabergoline, and transsphenoidal pituitary surgery is first-line therapy for other pituitary adenomas requiring treatment.

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Diagnosis and Treatment of Pituitary Adenomas

Cited by 814 publications

References 103 publications

Prolactinoma with galactorrhea and dysfunction erectile in man, a case report

Prolactinoma with galactorrhea and dysfunction erectile in man, a case report

Cushing Syndrome

Diagnosis and Management of Pituitary Adenomas

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