Clinical Review

Diagnosis and management of prolactinomas and non-functioning pituitary adenomas

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5390 (Published 10 September 2014) Cite this as: BMJ 2014;349:g5390
  1. Angela Rogers, Wellcome Trust clinical training fellow,
  2. Niki Karavitaki, consultant endocrinologist,
  3. John A H Wass, professor of endocrinology
  1. 1Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
  1. Correspondence to: J A H Wass john.wass{at}nhs.net

Summary points

  • Recognition of the presentation of pituitary tumours is critical as a favourable outcome depends on early diagnosis

  • The presentation of a pituitary macroadenoma relates to its mass effects and pressure on surrounding structures

  • Endocrine dysfunction will commonly be present with pituitary macroadenomas and should be actively investigated

  • It is vital to assess pituitary function at the time of diagnosis and doctors should have a low threshold for initiating hydrocortisone when there are features suggestive of adrenocorticotrophic hormone deficiency (for example, lethargy, fatigue, weight loss, hypotension)

  • Patients with pituitary adenomas require specialist management by a multidisciplinary team

Pituitary tumours account for a major proportion of intracranial tumours; most are benign adenomas. The tumours present with a range of signs and symptoms. Although evidence suggests that they are diagnosed earlier than previously, some are still missed, often for years, with clues such as headache and visual problems not being picked up.1 Management by a multidisciplinary team improves outcomes and optimises resources. This article focuses on the diagnosis and management of prolactinomas and non-functioning pituitary adenomas, which are the commonest types of pituitary adenoma in clinical practice.

Sources and selection criteria

We searched PubMed to identify peer reviewed original articles and reviews. Search terms were “pituitary tumour”, “pituitary adenoma”, “pituitary neoplasm”, and “prolactinoma”. We only considered those papers that were written in English and published within the past 20 years.

What are pituitary adenomas and how are they classified?

Pituitary adenomas are monoclonal benign tumours that arise from differentiated hormone expressing cells in the anterior pituitary. Five major cell types occur in the anterior pituitary: the lactrotroph, producing prolactin; the somatotroph, producing growth hormone; the corticotroph, producing adrenocorticotrophic hormone; the thyrotroph, producing thyroid stimulating hormone; and the gonadotroph, producing luteinising hormone and follicle stimulating hormone. Classification of pituitary adenomas is based in part on the cell type. Tumours that secrete hormones are called functioning adenomas …

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