Intended for healthcare professionals

Practice Easily Missed?

Pituitary adenomas

BMJ 2019; 365 doi: (Published 06 June 2019) Cite this as: BMJ 2019;365:l2091
  1. Aparna Pal, consultant endocrinologist1,
  2. Laurence Leaver, senior partner (GP)2,
  3. John Wass, consultant endocrinologist1
  1. 1Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2Green Templeton College, University of Oxford, Oxford, UK
  1. Correspondence to J Wass john.wass{at}

What you need to know

  • Check visual fields in patients presenting with headache coexisting with possible hypopituitary symptoms

  • Consider the diagnosis in men with fatigue and ask about low libido or erectile dysfunction; check 9 am testosterone, prolactin, luteinising hormone (LH), and follicle stimulating hormone (FSH)

  • Consider the diagnosis in women with oligo/amenorrhoea; check LH, FSH, oestradiol, and prolactin

A 58 year old man describes increasing fatigue and loss of motivation over a year. Routine blood tests are normal. He is going through a divorce and he and his GP agree that the symptoms are likely related to stress. On a routine eye check he is found to have a bitemporal hemianopia. Pituitary magnetic resonance imaging (MRI) reveals a 2.5 cm pituitary macroadenoma elevating and compressing the optic chiasm. On further questioning, the patient describes a four year history of erectile dysfunction.

Pituitary adenomas are often clinically silent or manifest with non-specific symptoms, which can lead to a delayed diagnosis. This article provides a summary of clinical features and investigations to help non-specialists and primary care doctors to recognise and diagnose pituitary adenoma.

How common are pituitary adenomas?

  • Pituitary adenomas are very common (up to 16% from autopsy and imaging studies) but only 0.1% progress to cause morbidity21

  • Previous population studies of pituitary adenomas have probably underestimated true prevalence. A community study of more than 80 000 inhabitants showed that prevalence of pituitary adenomas per 100 000 was fourfold higher than previous estimates at approximately 1:1000.22 Other population studies confirm this232425

  • From the third decade onwards, pituitary adenoma is the most common cause of an intrasellar mass

What is a pituitary adenoma?

Pituitary adenomas are benign tumours arising from hormone expressing cells in the anterior pituitary gland. They account for 10-25% of intracranial neoplasms1 and occur sporadically in most cases. They are broadly categorised as “functioning” (hormone secreting) and “non-functioning” (non-secreting) …

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