Pituitary Microadenomas Workup

  • Author: David M Klachko, MBBCh; Chief Editor: George T Griffing, MD   more...
 
Updated: May 18, 2011
 

Laboratory Studies

  • Current management strategies are controversial. In the absence of symptoms or signs suggesting excess of specific hormones, the most cost-effective strategy is simply measurement of the prolactin level.
  • If clinical suspicion of Cushing syndrome, acromegaly, or other hormone excess exists, order appropriate tests.[2, 3] Some experts recommend a screening panel of prolactin and insulinlike growth factor-1 (IGF-1) or somatomedin-C and an overnight dexamethasone suppression test.
  • Autonomous secretion by a tumor usually shows an inappropriate relationship between the level of the hormone secreted by the peripheral gland (thyroid, adrenal, gonadal) and the stimulating pituitary hormone (TSH,[4] ACTH, gonadotropins). For example, a patient may be hyperthyroid without TSH suppression (must be differentiated from thyroid hormone resistance) or a patient with Cushing disease, who will have an elevated or "normal" ACTH level.
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Imaging Studies

  • MRI studies (as seen in the image below) have shown sensitivity and specificity of about 90% for secretory tumors. Enhancement with gadolinium diethylenetriamine pentaacetic acid (DTPA) improves the detection rate. Sensitivity for detection of ACTH-secreting adenomas is much less (60-75%); diagnosis may require specialized tests such as petrosal sinus sampling. MRI showing a nonenhancing area in the pituitary cMRI showing a nonenhancing area in the pituitary consistent with a microadenoma in a patient with hyperprolactinemia.
  • CT scans are not very specific.
  • For secretory tumors, scintigraphy with [111 In-DTPA-D-Phe]-octreotide can identify tumors with somatostatin receptors.
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Other Tests

Other tests are dictated by the clinical picture of hormonal excess or, very rarely, hormonal deficiency. For larger functional microadenomas, especially those located in an area where upward pressure on the optic chiasma may exist, assessment of visual fields may be useful in monitoring therapy. Computer-assisted perimetry may be more sensitive than Goldman perimetry. In contrast to pituitary macroadenomas, microadenomas rarely cause any visual field defects.

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Histologic Findings

If the tumor is removed surgically, immunohistochemical staining for secretory granules is advisable.

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Staging

Staging is determined primarily by the size of the microadenoma.

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Contributor Information and Disclosures
Author

David M Klachko, MBBCh  Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri

David M Klachko, MBBCh is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Endocrine Society, Missouri State Medical Association, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Harris C Taylor, MD  Clinical Professor of Medicine, Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine

Harris C Taylor, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Thyroid Association, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Yoram Shenker, MD  Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison

Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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MRI showing a nonenhancing area in the pituitary consistent with a microadenoma in a patient with hyperprolactinemia.
 
 
 
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