What symptoms and exam findings would prompt you to perform a pituitary workup? What laboratory and neuroimaging studies would you order and why?
The pituitary gland, located at the base of the brain, is a small but powerful endocrine organ that plays a critical role in regulating several hormones that control various bodily functions. When there is a disruption in the function of the pituitary gland, it can lead to a variety of symptoms that require a pituitary workup. In this essay, we will discuss the symptoms and exam findings that would prompt a healthcare provider to perform a pituitary workup, as well as the laboratory and neuroimaging studies that would be ordered and why.
The symptoms and exam findings that would prompt a healthcare provider to perform a pituitary workup can be broad and variable, depending on the underlying condition. Some of the most common symptoms of pituitary dysfunction include:
- Headaches
- Vision changes or loss of peripheral vision
- Fatigue
- Weight gain or loss
- Mood changes
- Infertility or sexual dysfunction
- Skin changes or acne
- Increased or decreased urination
- Abnormal growth, such as gigantism or acromegaly
Exam findings that may indicate the need for a pituitary workup include an enlarged or tender pituitary gland, abnormalities in thyroid or adrenal function, or any concerning neurological signs or symptoms.
When a pituitary workup is necessary, the first step is usually to perform laboratory tests to assess hormone levels. The specific tests ordered will depend on the patient’s symptoms and suspected diagnosis, but commonly ordered tests include:
- Thyroid function tests
- Adrenocorticotropic hormone (ACTH) stimulation test
- Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels
- Growth hormone levels
- Prolactin levels
Additional laboratory tests may also be ordered based on the specific presentation of the patient.
If laboratory tests indicate abnormal hormone levels, imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be ordered to visualize the pituitary gland and identify any potential tumors or lesions. An MRI is the preferred imaging study for pituitary workup due to its higher resolution and ability to identify small tumors.
In some cases, specialized imaging studies such as a dynamic contrast-enhanced MRI or a magnetic resonance spectroscopy may be ordered to further evaluate the gland and help identify the specific nature of any suspected tumors or other abnormalities.
Overall, a pituitary workup is a critical step in evaluating and managing potential pituitary dysfunction. By identifying the underlying cause of symptoms and hormonal imbalances, healthcare providers can better manage and treat these conditions, leading to improved health and quality of life for their patients.