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Pituitary adenomas are also followed by serial imaging (usually MRI) to detect any increase in size or mass effect on nearby structures. If medical therapy fails, the second option is usually transphenoidal pituitary surgery . [ 68 ]
Many pituitary tumors (25%) are found to have areas of hemorrhagic infarction on MRI scans, but apoplexy is not said to exist unless it is accompanied by symptoms. [ 1 ] [ 4 ] In some instances, lumbar puncture may be required if there is a suspicion that the symptoms might be caused by other problems ( meningitis or subarachnoid hemorrhage ).
A CT or MRI of the pituitary may also show the ACTH-secreting tumor if present. However, in 40% of Cushing's disease patients MRI is unable to detect a tumor. [8] In one study of 261 patients with confirmed pituitary Cushing's disease, only 48% of pituitary lesions were identified using MRI prior to surgery.
Hyperpituitarism is a condition due to the primary hypersecretion of pituitary hormones; [3] [medical citation needed] it typically results from a pituitary adenoma.In children with hyperpituitarism, disruption of growth regulation is rare, either because of hormone hypersecretion or because of manifestations caused by local compression of the adenoma.
With pituitary adenomas larger than 1 cm, a baseline pituitary hormonal function test should be done, including measurements of serum levels of TSH, prolactin, IGF-1 (as a test of growth hormone activity), adrenal function (i.e. 24 hour urine cortisol, dexamethasone suppression test), testosterone in men, and estradiol in amenorrheic women. [11]
MRI is also superior for pituitary imaging. [20] It may however be less effective at identifying early cerebritis. [21] In the case of a concussion, an MRI should be avoided unless there are progressive neurological symptoms, focal neurological findings or concern of skull fracture on exam. [22]
Pituitary tumors often encroach upon the middle chiasm from below. Pituitary apoplexy is one of the few acute chiasmal syndromes. It can lead to sudden visual loss as the hemorrhagic adenoma rapidly enlarges. The embryonic remnants of Rathke's pouch may undergo neoplastic change called a craniopharyngioma. These tumors may develop at any time ...
Inferior petrosal sinus sampling (or IPSS), is a diagnostic medical procedure used to determine whether excess adrenocorticotropic hormone (ACTH) is coming from the pituitary gland (usually a pituitary adenoma causing Cushing's disease) or from a source outside the pituitary (a rare tumor causing ectopic ACTH syndrome). The procedure is usually ...