The majority of NFPAs are diagnosed incidentally or as a result of the mass effect (headache, visual disturbances, and neurological symptoms). Less often, deficient pitu itary hormone secretion, including gonadotropin deficiency, bring the patient to medical attention. These tumors can attain considerable size before manifesting clinically. A mild or moderate increase in the PRL level is common, but this increase is disproportionate to the tumor dimensions. A complete endocrine evaluation, including measurement of FSH, LH, testosterone, TSH, Free Thyroxine (FT)4, ACTH, cortisol, GH, and IGF-1, as well as prolactin, should be performed to exclude hypopituitarism. MRI with gadolinium enhancement and CT with intravenous contrast represent the best way to detect a pituitary tumor (78-80).

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