However, as with the case presented here, the coincident existence of a sellar mass should not preclude the possibility of an ectopic source. [ncbi.nlm.nih.gov]

Hyperprolactinemia Prolactin secreting pituitary adenomas present four times as frequently in women as in men. It should be noted that both the age of presentation and symptomatology at presentation are markedly different in the sexes. [med.virginia.edu]

Exophthalmous is present only in Grave’s disease (primary hypersecretion).[ 5 ] Non-secreting adenomas (neurological presentation) Hormonally inactive tumors tend to get to a larger size before detection. Non-specific sympthoms include headache. [primarycare.imedpub.com]

• Weight Gain

  Patients are often diagnosed with Cushing’s disease after several years of symptoms which might include progressive weight gain, new onset hypertension or diabetes and mood changes. [pacificneuroscienceinstitute.org]

  Typically, patients have the following clinical features 6 : rounded face, sometimes described as 'moon-shaped' progressive centripetal obesity and weight gain prominent supraclavicular fat pad, sometimes known as a 'buffalo hump' purple skin striae easy [radiopaedia.org]

  Symptoms include unexpected weight gain, easy bruising of the skin and muscle weakness. TSH-secreting pituitary adenoma ( thyrotropinoma ). Excessive TSH hormone production leads to hyperthyroidism. These tumors are very rare. [pituitary.ucla.edu]

  Symptoms and signs of Cushings syndrome and disease may include: Change in body habitus: weight gain in face (moon face), above the collar bone (supraclavicular) and on back of neck (buffalo hump) Skin changes with easy bruising, purplish stretch marks [pituitary.org]

  ACTH-secreting tumors can cause Cushing’s disease, with symptoms including rapid weight gain, hypertension, diabetes and skin changes. Growth hormone: This is the hormone that helps control body growth. [uofmhealth.org]

• Weight Loss

  Signs and symptoms include: Nausea and vomiting Weakness Feeling cold Less frequent or no menstrual periods Sexual dysfunction Increased amount of urine Unintended weight loss or gain Adrenocorticotropic hormone-secreting (ACTH) tumors ACTH tumors produce [mayoclinic.org]

  Loss Part 7: Oncology and Hematology Part 8: Infectious Diseases Part 9: Terrorism and Clinical Medicine Part 10: Disorders of the Cardiovascular System Part 11: Disorders of the Respiratory System Part 12: Critical Care Medicine Part 13: Disorders of [accessmedicine.mhmedical.com]

  JUN 2001; 40 (6) : 510-514 Lamb-EJ; Muller-AF; Flynn-MD An unusual case of diarrhoea and weight loss - Isolated ACTH deficiency. POSTGRADUATE-MEDICAL-JOURNAL. [malattierare.regione.veneto.it]

  Symptoms of hyperthyroidism: Rapid heart rate Weight loss Sweating Tremors Anxiety Enlarged thyroid. Gonadotropin-Secreting Pituitary Adenoma Excess gonadotropins (LH and FSH) disrupt reproductive processes. [innerbody.com]

  Tumors that elaborate TSH produce signs and symptoms of thyrotoxicosis, such as heat intolerance, sweating, tachycardia, fine tremor, and weight loss. Some tumors may secrete more than one hormone, such as GH and PRL. [emedicine.medscape.com]

• Surgical Procedure

  In the event of a noncure, a second surgical procedure with a more aggressive exploration of the pituitary gland for tumor is usually effective, since the most common cause of surgical failure is that the adenoma could not be found. 62 If IPSS was not [ncbi.nlm.nih.gov]

  Surgical procedures like carpal tunnel releases and lumbar decompressions are also not uncommonly done prior to the underlying diagnosis being made. [med.virginia.edu]

  Treatment depends on the type of pituitary tumor: ACTH-producing tumor — Most people with this type of pituitary tumor undergo a surgical procedure called transsphenoidal hypophysectomy. [drugs.com]

• Malaise

  […] ketosisケトーシス、ケトン症 Kussmaul's breathingク［ー］スマウル［大］呼吸〈糖尿病性大呼吸〉 l ligation 結紮 lipolysis脂肪分解 lipoproteinリポ蛋白［質］、リポプロテイン low-density lipoprotein (LDL)低比重リポ蛋白 luteinizing hormone-releasinghormone (LH-RH)LH放出ホルモン m macular edema (ME)黄斑浮腫 malabsorption吸収不良 malaise [tokyo-med.ac.jp]

• Easy Bruising

  […] susceptibility Bruise easily Easy bruisability Easy bruising [ more ] 0000978 Depressivity Depression 0000716 Diabetes mellitus 0000819 Fatigue Tired Tiredness [ more ] 0012378 Generalized hirsutism Excessive hairiness over body 0002230 Hypertension [rarediseases.info.nih.gov]

  Symptoms and signs of Cushings syndrome and disease may include: Change in body habitus: weight gain in face (moon face), above the collar bone (supraclavicular) and on back of neck (buffalo hump) Skin changes with easy bruising, purplish stretch marks [pituitary.org]

  […] of Cushing’s syndrome: patients with Cushing’s disease usually present with one or more signs and symptoms secondary to the presence of excess cortisol Symptoms include: moon face (resulting in a large chin and large forehead) extra fat around neck easy [pietromortini.com]

  Cushing’s Disease Symptoms The most common symptoms of Cushing’s disease are: unexplained weight gain, particularly around the neck and midsection, thinning of the arms and legs and muscle weakness, diabetes, high blood pressure, easy bruising, moodiness [mskcc.org]

  The symptoms resulting from excess ACTH and cortisol are quite different and include mainly weight gain (central distribution), high blood pressure, fatigue, excess hair growth and menstrual irregularities in woman, skin thinning, easy bruising/ecchymosis [csrf.net]

• Failure to Thrive

  Showing of 61 | 80%-99% of people have these symptoms Adrenal hyperplasia Enlarged adrenal glands 0008221 Failure to thrive Faltering weight Weight faltering [ more ] 0001508 Lipodystrophy Inability to make and keep healthy fat tissue 0009125 Pituitary [rarediseases.info.nih.gov]

• Osteoporosis

  In both cases, patients with low sex hormones develop osteoporosis. It is important to remember that most pituitary tumors are benign and cancer is very rare. [neurosurgery.emory.edu]

  […] cause Cushing’s syndrome, characterized by signs and symptoms that may include weight gain around the trunk and in the face, stretch marks, easy bruising, a hump on the upper back, muscle weakness, tiredness, thin bones that are prone to fracture ( osteoporosis [rarediseases.info.nih.gov]

  […] as 'moon-shaped' progressive centripetal obesity and weight gain prominent supraclavicular fat pad, sometimes known as a 'buffalo hump' purple skin striae easy skin bruising acanthosis nigricans proximal myopathy depression and other mood disorders osteoporosis [radiopaedia.org]

  Cushing’s disease or syndrome is often associated with significant morbidities, such as diabetes mellitus, cardiovascular disease, osteoporosis, reduced quality of life, and increased mortality. The following are the most common symptoms. [adrenaltumors.org]

  Causes of Cushing's Syndrome Testing for Cushing's Syndrome Treatment of Cushing's Syndrome In 1932, a physician named Harvey Cushing described 8 patients with central body obesity, glucose intolerance, hypertension, excess hair growth, osteoporosis, [endocrineweb.com]

• Muscle Weakness

  Symptoms may include: upper body obesity round face increased fat around neck thinning arms and legs fragile and thin skin stretch marks on abdomen, thighs, buttocks, arms, and breasts bone and muscle weakness severe fatigue high blood pressure high blood [adrenaltumors.org]

  Possible signs and symptoms of Cushing's syndrome include: Fat accumulation around your midsection and upper back Exaggerated facial roundness Thinning of the arms and legs with muscle weakness High blood pressure High blood sugar Acne Bone weakening [mayoclinic.org]

  Patients with Cushing's may develop diabetes mellitus, high blood pressure, muscle weakness, clotting disorders, infections and obesity. Bone loss with pathologic fractures can occur. [pituitary.mgh.harvard.edu]

  It is part of a group of diseases that cause Cushing’s syndrome, characterized by signs and symptoms that may include weight gain around the trunk and in the face, stretch marks, easy bruising, a hump on the upper back, muscle weakness, tiredness, thin [rarediseases.info.nih.gov]

  Cushing’s Disease Symptoms The most common symptoms of Cushing’s disease are: unexplained weight gain, particularly around the neck and midsection, thinning of the arms and legs and muscle weakness, diabetes, high blood pressure, easy bruising, moodiness [mskcc.org]

• Hyperpigmentation

  Over the ensuing years, the patient developed Nelson's syndrome with hyperpigmentation and markedly elevated ACTH levels. [ncbi.nlm.nih.gov]

  Furthermore, certain patient groups may demonstrate additional or atypical clinical features depending on the etiology of Cushing syndrome 6 : patients with Cushing disease: hyperpigmentation, because melanocyte-stimulating hormone (MSH) and adrenocorticotropic [radiopaedia.org]

  Hyperpigmentation is often seen and when the adenoma grows large enough there may be visual field defects or cranial nerve symptoms. [path.upmc.edu]

  Avascular necrosis Death of bone due to decreased blood supply 0010885 Bipolar affective disorder Bipolar disorder 0007302 Cardiomyopathy Disease of the heart muscle 0001638 Cataract Clouding of the lens of the eye Cloudy lens [ more ] 0000518 Generalized hyperpigmentation [rarediseases.info.nih.gov]

  Neverthless, hyperpigmentation is a possible but rarely observed finding. Sometimes a psychiatric condition can be associated and, in a more advanced phase, osteoporosis and muscle wasting can become evident. [primarycare.imedpub.com]

• Paresis

  Patients will often complain that they have trouble with anteroposterior tasks such as cutting fingernails, threading needles, and working with precision tools. [23] Diplopia Diplopia may be due to cranial nerve paresis from lateral extension of tumors [eyewiki.aao.org]

  In a series analyzing 40 cases of pituitary apoplexy, the presenting signs and symptoms included headache (63%), vomiting (50%), visual field defects (61%), ocular paresis (40%), mental deterioration (13%), hyponatremia (13%), and syncope (5%); in only [cancer.gov]

• Amenorrhea

  It is important to remember that the main cause of amenorrhea in females of reproductive potential is pregnancy! [primarycare.imedpub.com]

  Acromegaly is associated with enlargement of facial features, hands and feet, heart disease, hypertension, arthritis, carpel tunnel syndrome, amenorrhea, and impotence. [emedicine.medscape.com]

  Galactorrhea, amenorrhea, decreased libido, and infertility. Age is usually greater than 20-25 What pituitary tumors have a high recurrence rate after resection? TSH secreting tumors. [quizlet.com]

  […] buffalo hump) Skin changes with easy bruising, purplish stretch marks (stria) and red cheeks (plethora) Excess hair growth (hirsutism) on face, neck, chest, abdomen, and thighs Generalized weakness and fatigue Loss of muscle Menstrual disorders in women (amenorrhea [pituitary.org]

  Much more often, it causes absent periods (amenorrhea). In men, it causes impotence and decreased sex drive. [drugs.com]

• Sexual Dysfunction

  In contrast, men usually present in the fourth or fifth decades of life and have sexual dysfunction and symptoms related to mass effect attributable to an enlarging sellar mass. [med.virginia.edu]

  Signs and symptoms include: Nausea and vomiting Weakness Feeling cold Less frequent or no menstrual periods Sexual dysfunction Increased amount of urine Unintended weight loss or gain Adrenocorticotropic hormone-secreting (ACTH) tumors ACTH tumors produce [mayoclinic.org]

  In the early phases, patients complain about one of the symptoms, but after a careful inspection, a constellation of signs and symptoms can be detected.[ 2, 3 ] Sexual dysfunction with decreased libido is one of the main initial complaints (eventually [primarycare.imedpub.com]

• Oligomenorrhea

  […] intolerance 0001952 Hirsutism Excessive hairiness 0001007 Increased circulating ACTH level High blood corticotropin levels 0003154 Kyphosis Hunched back Round back [ more ] 0002808 Mood changes Moody 0001575 Obesity Having too much body fat 0001513 Oligomenorrhea [rarediseases.info.nih.gov]

  The clinical presentation can be subtle and generally patients refer to the GP for oligomenorrhea, irregular menstrual cycles, galactorrhea (spontaneous or expressive through squeezing on the nipples). [primarycare.imedpub.com]

  Men may have erectile dysfunction, whereas premenopausal women often experience oligomenorrhea or amenorrhea 6, 11 ( Table 1 5 – 12 ). [aafp.org]

  Oligomenorrhea or amenorrhea. Reduced fertility. Loss of libido. Erectile dysfunction. Galactorrhea in the estrogen-primed female breast. [cancer.gov]

[…] ovarian tumors adrenocorticotropin (ACTH)-independent macronodular adrenocortical hyperplasia (AIMAH) : rare cause of ACTH-independent Cushing syndrome 4 corticotropin-releasing hormone-secreting tumor: very rare hypothalamic tumors ectopic production The workup [radiopaedia.org]

GENERAL PRINCIPLES OF DIAGNOSIS AND TREATMENT Patients presenting with signs and symptoms suggestive of a pituitary adenoma require a comprehensive workup and treatment plan reflecting a strong interdisciplinary effort with endocrinologists, neurosurgeons [med.virginia.edu]

While a majority of patients with endogenous Cushing syndrome have thyrotrophic adenomas (called Cushing Disease - see below), other tumors should also be considered as part of the endocrinologic workup, including adrenal tumors and especially ACTH-secreting [eyewiki.aao.org]

Dynamic pituitary MRI has high sensitivity and specificity for diagnosis of mild Cushing's syndrome and should be part of the initial workup. Horm Metab Res. 2007;39(6):451–456. 22. Rennert J, Doerfler A. Imaging of sellar and parasellar lesions. [aafp.org]

• Enlarged Sella

  Empty Sella An empty sella occurs as a result of herniation of the arachnoid through an incompetent diaphragma sellae. Over time, cerebrospinal fluid (CSF) pulsations may enlarge the sella and compress the gland against the floor of the sella. [emedicine.medscape.com]

Radiation and pharmaceutical treatment may be alternative for recurrent Cushing disease. [ncbi.nlm.nih.gov]

Treatment for Cushing’s Disease The primary treatment for Cushing’s disease is surgery to remove the pituitary tumor. [mskcc.org]

As the treatment time or treatment concentration increased, KML001 significantly increased the percentage of AtT-20 cells in apoptosis. [endocrine-abstracts.org]

Surgery can also be used when drug treatment doesn't work. Radiation may be used if drug treatment and surgery do not work. [cancer.org]

Treatment and prognosis Management depends on the specific etiology 6. [radiopaedia.org]

Surgical removal has a guardedly favorable prognosis, but long-term follow-up is required. [skullbaseinstitute.com]

People with small tumors that do not need immediate treatment or can be completely removed with surgery have an excellent prognosis. Even for large tumors that interfere with vision, surgery can stop further deterioration of vision. [drugs.com]

Prognosis Remission can be obtained in up to 90% of patients with microadenomas and in about 50% to 60% of those with macroadenomas. [ 1 ] [patient.info]

Additionally, it can result in Nelson syndrome in 10% to 30% of patients and carries a generally unfavorable prognosis. [ncbi.nlm.nih.gov]

Treatment and prognosis Management depends on the specific etiology 6. [radiopaedia.org]

In none of these cases, however, was the diagnosis of an ACTH-secreting chromophobe adenoma established at the outset, and the present evidence favoring a pituitary etiology is based on retrospective reasoning and demonstration of abnormally high levels [nejm.org]

[…] stimulation is also advocated in conjunction with the dexamethasone suppression test in order to increase sensitivity. 55 In patients where this testing is not compelling, inferior petrosal sinus sampling (IPSS) must be performed to confirm the pituitary etiology [ncbi.nlm.nih.gov]

Hyperprolactinemia Present Biologically inactive form of prolactin, with no pathologic association Useful to check in patients with hyperprolactinemia who have moderate elevations (100 to 300 mcg per L [4,348 to 13,043 pmol per L]) of serum prolactin with unknown etiology [aafp.org]

Etiologies of Hyperprolactinemia (adapted from M.E. [ocw.tufts.edu]

Table 1 outlines the epidemiology, clinical and tumour features, genetics and treatment of different PPAs Table 1 Epidemiology, clinical and tumour features, genetics and treatment of different PPAs Molecular Pathogenesis In recent years genetic defects [karger.com]

Epidemiology [ 1 ] Pituitary tumours account for 10% to 25% of all intracranial neoplasms. Adenomas account for the largest portion of pituitary neoplasms (estimated at approximately 17%). Only a minority of adenomas are symptomatic. [patient.info]

PMID 12763000 The epidemiology of endocrine tumours. Monson JP Endocrine-related cancer. 2000 ; 7 (1) : 29-36. PMID 10808194 Incidence, Pathology, and Recurrence of Pituitary Adenomas: Study of 647 Unselected Surgical Cases. [atlasgeneticsoncology.org]

Jorgensen, Epidemiology of Cushing’s syndrome. Neuroendocrinology 92 (1), 1–5 (2010) PubMed CrossRef Google Scholar 2. R.N. Clayton, D. Raskauskiene, R.C. Reulen, P.W. [link.springer.com]

Cryptococcal meningitis : epidemiology and therapeutic options. Clin Epidemiol 2014;6:169–82. [5]. Lui G, Lee N, Ip M, et al. Cryptococcosis in apparently immunocompetent patients. QJM 2006;99:143–51. [6]. Nicholas J, Sarlis SJC, Lynnette K. [journals.lww.com]

Because of their pathophysiological characteristics, anterior hypophysis tumors can be generally divided in functional and nonfunctional. [primarycare.imedpub.com]

Rovit RL, Duane TD : Cushing's syndrome and pituitary tumours: pathophysiology and ocular manifestation of ACTH- secreting pituitary adenomas. Am J Med1969; 46 : 416-427. 4. Rovit RL, Fein JM : Pituitary apoplexy: A review and reappraisal. [neurologyindia.com]

The exact pathophysiology of this phenomenon is unknown; however, as most of these lesions involve the chiasm and/or diencephalon, many have proposed that disruption of visual and vestibular input contribute to this pathology. [eyewiki.aao.org]

[…] syndrome Symptoms from mass effect; hypopituitarism; silent (nonfunctioning) No specific corresponding test Pituitary carcinoma None No specific syndrome Symptoms from mass effect; hypopituitarism; silent (nonfunctioning) No specific corresponding test Pathophysiology [aafp.org]

It also suggests, however, that pituitary adenomas may arrive by different pathophysiologic pathways. Non-hormone-secreting pituitary tumors tend to grow slowly and insidiously. [glowm.com]

Promising preventive measures may include preoperative routine sputum smear and India-ink stain for screening, preoperative treatment of cryptococcal pneumonia, postoperative antibiotic management, and a more secure skull base reconstruction. [ncbi.nlm.nih.gov]

It may be recommended as additional therapy after surgery to prevent regrowth of the tumor. Radiation may also be used as the sole treatment if the tumor cannot be removed surgically, or if the tumor regrows after surgery. [mskcc.org]

We believe seeing both specialists at the same time reduces anxiety and uncertainty for the patient, and prevents having to go back and forth between specialists. [uofmhealth.org]

Prevention Pituitary adenomas are not associated with any known lifestyle or environmental risk factors, so there are no available methods to prevent the condition. [innerbody.com]

Prevention Because doctors do not know why pituitary tumors develop, there is no way to prevent them. [drugs.com]