presentation of pituitary tumours
Last reviewed 03/2023
Pituitary tumours may present because of either their mass their or endocrine effects.
Mass effects are usually due to large tumours and include:
- headache - non-specific
- visual field defects - from pressure on the inferior of the optic chiasm; begins as a superior temporal quadrantanopia progressing to bitemporal hemianopia
- cavernous sinus compression - resulting from lateral extension of the tumour into the cavernous sinus. Most often produces a III nerve palsy; may also compress the IV and VI nerves, and produce sensory loss in the first and second divisions of cranial V.
- rarely, erosion of the mass through the sphenoid sinus produces a CSF rhinorrhoea
Endocrine effects may be due to oversecretion of specific hormones, usually one, especially caused by small tumours:
- hyperprolactinaemia - most common
- gigantism / acromegaly - from GH hypersecretion
- Cushing's disease - from ACTH hypersecretion - presents as Cushing's syndrome
- rarely, hypersecretion of TSH, FSH, LH
Or due to undersecretion of specific hormones, presenting as panhypopituitarism. This may be associated with compression of the pituitary gland from a large tumour, or may result from small tumours.
Pituitary adenomas may also present as pituitary apoplexy.