PITUITARY-INCIDENTALOMA

SUMMARY

1. Incidentally found on imaging.

2. Test visual fields formally.

3. Blood investigations: serum PRL, IGF-1, LH, FSH, testosterone, TSH, free T4, morning cortisol, 24-hour urinary free cortisol.

4. Do low-dose overnight dexamethasone suppression test if cortisol-excess is suspected: HTN, hyperglycemia & other physical characteristics.

5. If asymptomatic/no visual field disturbance: follow-up 6 monthly with repeat imaging.

6. Indications for surgery: visual field disturbance, impingement on the optic chiasm, apoplexy, mass effect (if large enough), acromegaly, Cushing's.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].