|
|
MJA Practice Essentials--Endocrinology. 9:
Pituitary disease in adults
Hurley DM, Ho KK
Department of Endocrinology and Diabetes, Royal Perth Hospital,
Wellington Street Campus, Box X2213, GPO, Perth, WA 6847, Australia.
dmhurley@telstra.com
Pituitary adenomas are found in 10%-25% of unselected autopsy series and are
evident in about 10% of asymptomatic individuals by magnetic resonance
imaging.
Diagnosis of pituitary disorders is often delayed by lack of awareness and the
subtlety of symptoms and signs.
Hypopituitarism is suspected when peripheral hormone concentrations are low
without an elevation in the corresponding pituitary tropic hormone(s).
Severe adult-onset growth-hormone deficiency results in reduced muscle mass,
increased fat mass and diminished quality of life, which are reversed by growth
hormone replacement therapy.
While trans-sphenoidal surgery remains first-line treatment for acromegaly, drug
treatment has an important role in controlling residual growth-hormone excess
and, in some circumstances, as first-line treatment.
Dopamine-agonist therapy (cabergoline or bromocriptine) is the treatment of
choice for micro- and macroprolactinomas.
In patients with suggestive clinical features, elevated 24-hour urine free
cortisol level is usually sufficient to diagnose endogenous Cushing's syndrome;
careful additional investigation is needed to determine whether the cause is
Cushing's disease (pituitary adenoma secreting adrenocorticotropic hormone
[ACTH]), ectopic ACTH secretion or adrenal disease.
Heightened awareness is needed to detect the sometimes subtle symptoms and signs
of pituitary disease
PMID: 15089738 [PubMed - in process]
|
