Clinical Presentation

The patient with a pituitary lesion usually presents in a combination of one or more of four ways.

• Endocrine dysfunction. Overproduction is most commonly seen in prolactinoma, for which surgery is not usually first-line therapy. It is also seen in acromegaly, Cushing's disease (CD), and, rarely, secondary hyperthyroid-

From: Management of Pituitary Tumors: The Clinician's Practical Guide, Second Edition Edited by: M. P. Powell, S. L. Lightman, and E. R. Laws, Jr. © Humana Press Inc., Totowa, NJ

ism. Underproduction may result from the presence of a large nonfunctioning tumor.

• Local pressure symptoms, especially with impairment of visual fields or visual acuity, and more rarely with dysfunction of cranial nerves III to VI, including trigeminal neuralgia.

• Headache, sometimes related to dural distortion around the pituitary fossa. Infrequently it is associated with other raised intracranial pressure symptoms, such as drowsiness. Headache is also prevalent in patients with small adenomas without mass effect, and there is emerging evidence of a neurovascular pattern to this headache that may suggest a neuroendocrine cause (Levy M, Goadsby P, personal communication). In pituitary apoplexy, subarachnoid hemorrhage may contribute to acute headache.

• Incidental discovery during scanning for some other purpose.

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