FEATURE: MELISSA WASILENKO, MSN, RN
Workup for Incidental Pituitary Adenoma in Primary Care Setting Pituitary gland tumors are often found incidentally on imaging studies or during workup for abnormal endocrine hormone levels.
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Approximately 65% of pituitary adenomas are functioning tumors.
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35-year-old woman is seen for evaluation of an incidental pituitary macroadenoma. Her medical history is significant for hypertension, diabetes, hyperlipidemia, polycystic ovary syndrome, and obesity. She initially presented to the emergency department (ED) a week ago after an episode of right visual field changes that she described as waviness in her right eye and right hemibody sensory changes without motor deficits.While in the ED, she underwent a full workup for possible stroke, which was negative. Magnetic resonance imaging (MRI) of her brain without contrast revealed a 12-mm pituitary lesion; a repeat MRI with contrast was then ordered (Figure, page 12). No serum hormonal panel was available for review from ED records. Upon further questioning of her medical history, the patient notes that a few years ago she was attempting to become pregnant and was evaluated by her gynecologist for amenorrhea.At that time, she reportedly completed an endocrine laboratory workup that showed a slightly elevated prolactin level between 30 and 40 ng/mL (normal level in nonpregnant women, <30 ng/mL). Per the patient, the minimal elevation was not enough to concern the gynecologist and no MRI was ordered at that time. Her gynecologist recommended that she lose weight. Her menses returned to normal with weight loss. With a history of disrupted menstrual cycles, infertility, and patient-reported elevated prolactin level, there is high suspicion for endocrine disruption.
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