Which clinical history findings are characteristic of pituitary macroadenomas?

Updated: Mar 23, 2018
  • Author: James R Mulinda, MD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

Patients with pituitary macroadenomas may be asymptomatic or may present with complaints due to hormonal imbalance or mass effects.

Tumors in asymptomatic patients may be discovered when imaging the head for unrelated medical conditions. The frequency of diagnosis of pituitary tumors has increased with widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) scans.

Pituitary hormone effects depend on the hormones involved. Panhypopituitarism may present with a deficiency of all the pituitary hormones, but often some are spared. The larger the tumor, the more likely it is to involve most hormones. Anterior pituitary cells are not equally sensitive to mass effects. The most sensitive are the somatotrophs and the gonadotrophs, whereas corticotrophs and thyrotrophs tend to be more resistant. Distinct clinical syndromes, specifically the following, are the result of the hormonal activity of the tumor:

Hyperprolactinemia presents with hypogonadism, infertility, amenorrhea, and galactorrhea. Hyperprolactinemia can be due to increased hormone production by a prolactinoma, or it can be the result of stalk compression by the macroadenoma regardless of hormone activity. In this regard, it is a very common sequela of a pituitary macroadenoma.


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