DISEASES OF THE PITUITARY - CLINICAL FINDINGS
Pancreatic Disease	Symptoms	Signs	Abnormal Lab Test Results	Abnormal Imaging Findings	Initial Treatment	General and Follow-Up Treatment	Age Range(s) Typically Found	Prognosis
Prolactinoma	Amenorrhea, galactorrhea, infertility, decreased libido, headaches	Galactorrhea, hypogonadism signs, bitemporal hemianopsia if large	↑Prolactin (>200 ng/mL), ↓LH, ↓FSH, mild ↓Testosterone/Estrogen	Pituitary tumor on MRI (microadenoma <1 cm, macroadenoma >1 cm)	Dopamine agonists (cabergoline, bromocriptine), surgery if large	Monitor prolactin levels, MRI follow-up if large	Women 20-40 years, men later due to late diagnosis	Good with treatment, infertility may persist if untreated
Acromegaly	Enlarged hands/feet, coarse facial features, joint pain, sweating	Frontal bossing, macroglossia, hypertension, carpal tunnel syndrome	↑IGF-1, failure of GH suppression with glucose tolerance test	Pituitary adenoma on MRI, enlarged sella turcica	Surgical removal of adenoma, somatostatin analogs if non-surgical	GH and IGF-1 monitoring, MRI follow-up, lifelong surveillance	Adults 30-50 years, slow onset	Good with treatment, but increased mortality risk from cardiovascular disease
Cushing’s Disease	Weight gain, moon face, buffalo hump, muscle weakness, easy bruising	Central obesity, purple striae, proximal muscle weakness	↑ACTH, ↑Cortisol, failure to suppress with dexamethasone	Pituitary tumor on MRI, usually microadenoma	Transsphenoidal surgery, ketoconazole/metyrapone if not surgical	Regular cortisol and ACTH testing, MRI monitoring	Adults 20-50 years, more common in women	Good with treatment, untreated cases have high morbidity
Non-Functioning Pituitary Adenoma	Headaches, vision changes, hypopituitarism symptoms	Bitemporal hemianopsia, hypogonadism signs if large	Normal or low pituitary hormones, hypopituitarism pattern	Pituitary mass on MRI, compressing optic chiasm	Surgical removal if symptomatic, hormone replacement as needed	Hormonal monitoring, repeat MRI if growing	Middle-aged to older adults	Good if treated early, may lead to permanent hypopituitarism
Central Diabetes Insipidus	Polyuria, polydipsia, nocturia, dehydration symptoms	Hypotension, hypernatremia, dilute urine	↓ADH, ↑Serum osmolality, ↓Urine osmolality	No mass, loss of posterior pituitary bright spot on MRI	Desmopressin (DDAVP) for ADH replacement	Lifelong desmopressin therapy, monitor sodium levels	Any age, commonly post-neurosurgery or trauma	Good with treatment, but lifelong therapy needed
SIADH (Syndrome of Inappropriate ADH Secretion)	Hyponatremia symptoms, nausea, confusion, seizures in severe cases	Hyponatremia, normal to low serum osmolality, concentrated urine	↑ADH, ↓Serum sodium, ↓Serum osmolality, ↑Urine osmolality	No specific pituitary mass, signs of cerebral edema	Fluid restriction, hypertonic saline if severe	Monitor serum sodium, fluid balance, treat underlying cause	Older adults, post-surgical or malignancy-related	Good if underlying cause treated, severe cases may be fatal
Hypopituitarism	Fatigue, cold intolerance, loss of secondary sexual characteristics	Pale skin, hair loss, signs of adrenal insufficiency	↓ACTH, ↓TSH, ↓LH/FSH, ↓GH, ↓Prolactin (except in stalk compression)	Small pituitary gland, empty sella syndrome in some cases	Hormone replacement (hydrocortisone, levothyroxine, sex steroids)	Lifelong hormone replacement therapy, monitor deficiencies	Any age, congenital or acquired	Variable, lifelong management needed
Pituitary Apoplexy	Sudden severe headache, visual disturbances, nausea, hypotension	Decreased consciousness, ophthalmoplegia, visual loss	↑Prolactin, ↓ACTH, ↓TSH, ↓LH/FSH due to sudden pituitary dysfunction	Hemorrhagic infarct of pituitary gland on MRI/CT	Emergency steroids, surgery if mass effect, supportive care	Close monitoring for recurrence, hormone replacement as needed	Middle-aged to older adults, risk increased with pituitary tumors	Variable, good with early intervention, fatal if untreated