Hyperfunctioning Pituitary Adenomas Key Points

• Pituitary adenomas may present with visual impairment, headache, or hormonal abnormalities.

• Prolactinomas are the most common type of functioning pituitary adenoma and manifest with galactorrhea and hypogonadism.

• Nonpathologic causes of hyperprolactinemia are sought, and primary hypothyroidism is excluded.

• MRI is the imaging modality of choice for the anatomic evaluation of the hypothalamus and pituitary gland.

• Prolactin level over 150 ng/mL and pituitary adenoma not identified on imaging suggest macroprolactinemia.

• A dopamine agonist (bromocriptine or cabergoline) is first-line treatment of prolactinomas.

Pituitary adenomas can arise from any cell type and can be functioning or nonfunctioning. The precise pathogenesis of these adenomas is not known but mutations found in several genes can play a role in the development of many adenomas. With prolactinomas the most common type, other functioning pituitary adenomas include gonadotropic, thyrotropic, somatotropic, and corticotropic adenomas.

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