Hyperpituitarism Differential Diagnoses

Updated: Jun 30, 2020
  • Author: Alicia Diaz-Thomas, MD, MPH; Chief Editor: Robert P Hoffman, MD  more...
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DDx

Diagnostic Considerations

The differential diagnosis of hyperprolactinemia includes prolactinomas and disorders that lead to loss of dopaminergic suppression of the pituitary lactotrophs, such as tumors of the pituitary, destruction of the hypothalamus, nipple or chest wall stimulation, pregnancy, or pharmacologic agents (notably risperidone and related agents). [10]

The differential diagnosis of hypercortisolism includes corticotropinomas as well as primary adrenal tumors and ectopic adrenocorticotropic hormone (ACTH)-producing tumors. Exceedingly rare cases of ectopic ACTH production in childhood have been described in association with tumors, such as thymoma, Wilms tumor, adrenal rest tumor, and pancreatic neoplasm. Ectopic ACTH production is rarely present in bronchial or thymic carcinoids.

The differential diagnosis of tall stature includes the following:

The differential diagnosis of growth hormone (GH) excess includes somatotropinomas and diseases in which increased secretion of growth hormone–releasing hormone (GHRH) occurs, either from an intracranial or ectopic source, and diseases in which dysregulation of the hypothalamic-pituitary-GH axis occurs.

Several well-documented cases of intracranial gangliocytomas associated with gigantism or acromegaly are known. Ectopic GHRH-secreting tumors have included carcinoid, pancreatic islet cell, and bronchial neoplasms. Note that somatotropinomas occasionally may occur as a feature of other conditions, such as multiple endocrine neoplasia type 1 (MEN1), McCune-Albright syndrome (MAS), neurofibromatosis, tuberous sclerosis, or Carney complex.

Differential Diagnoses