Gender Ethnicracial And Life Span Considerations

Approximately 70% of pituitary tumors occur in people between 30 and 50 years of age. Only 3% to 7% occur in people younger than 20 years, and twice as many females as males have the condition. Women of childbearing age have a higher prevalence of pituitary adenomas than do men. No racial or ethnic considerations have been identified.

^ ASSESSMENT

HISTORY. Ask the patient to describe any endocrine or neurological symptoms. Usually, patients give a history of slowly developing, progressive symptoms. They frequently complain of headaches, visual disturbances (blurred vision or double vision progressing to blindness), decreased sexual interest, menstrual irregularities, and impotence. Family members may report central nervous system (CNS) changes, such as anxiety, personality changes, seizure activity, and even dementia. Depending on tumor type, patients may describe weakness, fatigue, sensitivity to cold, and constipation.

PHYSICAL EXAMINATION. You may note that the skin has a waxy appearance; fewer than normal wrinkles for the patient's age; and a decreased amount of body, pubic, and axillary hair. Assess the patient's skin for hyperpigmentation, oiliness, acne, and diaphoresis. Assessment of visual function is important because pituitary tumors may press on the optic chiasm. Assess the patient's visual fields, visual acuity, extraocular movements, and pupillary reactions. A classic finding is bitemporal hemianopsia (blindness in the temporal field of vision). Perform an assessment of the cranial nerves. The tumor may involve cranial nerves III (oculomotor, which regulates pupil reaction), IV (trochlear, which along with the abducens regulates conjugate and lateral eye movements), and VI (abducens). Examine the patient's musculoskeletal structure, determining whether foot and hand size are appropriate for body size; whether facial features are altered, such as thick ears and nose; and whether the skeletal muscles are atrophied.

PSYCHOSOCIAL. The patient may have personality changes such as irritability and even occasional hostility. Assess the patient's interpersonal relationships, the response of significant others, and the patient's and significant others' abilities to cope with a potentially serious illness. Patients may be concerned about body image, fertility, and sexual performance.

730 Pituitary Tumor

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Growth hormone

<10 ng/mL

Elevated

Functional (hormone-producing) tumor elevates levels of various hormones

Gonadotrophins: Follicle-stimulating hormone (FSH)

Luteinizing hormone (LH)

Adult male: 2-18 IU/L Adult female: 5-20 IU/L (follicular or luteal) 30-50 IU/L: (midcycle peak)

Adult male: 2-18 IU/L Adult female: 5-12 IU/L (follicular or luteal) 30-250 IU/L (midcycle peak)

Elevated Elevated

Functional (hormone-producing) tumor elevates levels of various hormones

Functional (hormone-producing) tumor elevates levels of various hormones

Prolactin

0-20 ng/mL

Elevated

Functional (hormone-producing) tumor elevates levels of various hormones

Thyrotropin (thyroid-stimulating hormone [TSH])

1.0-6.2 |jU/mL

Elevated

Functional (hormone-producing) tumor elevates levels of various hormones

Adrenocorticotropic hormone (ACTH)

<60 pg/mL

Elevated

Functional (hormone-producing) tumor elevates levels of various hormones

Magnetic resonance imaging (MRI)

No visual evidence of tumors; normal brain structure

Provides visual evidence of tumors

Standard imaging test to identify pituitary tumors; can identify macroadenomas and microadenomas >3 mm; can locate small abnormalities in pituitary gland unrelated to symptoms; 5%-25% of patients have unrelated minor abnormalities of pituitary gland

Other Tests: Biopsy of pituitary tissue

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