Differentials
Pituitary macroadenoma
SIGNS / SYMPTOMS
Headache and bitemporal hemianopia symptoms related to other pituitary hormonal deficiencies; for example, weight loss and nausea due to adrenal insufficiency, or cold intolerance and constipation due to hypothyroidism.
INVESTIGATIONS
Low luteinising hormone and follicle stimulating hormone levels with pituitary macroadenoma.
Possible low thyroxine, triiodothyronine, and cortisol levels.
MRI of the pituitary reveals pituitary lesion.
Prolactinoma
SIGNS / SYMPTOMS
Headache, bitemporal hemianopia, and occasional galactorrhoea.
INVESTIGATIONS
MRI of the pituitary reveals pituitary lesion.
Serum prolactin elevated.
Hyperprolactinaemia
SIGNS / SYMPTOMS
Galactorrhea (exceptionally rare).
Headache may be present if hyperprolactinaemia is secondary to prolactinoma.
INVESTIGATIONS
Elevated prolactin levels. Hypothyroidism and medicines such as dopamine antagonists should be excluded.
Depression
SIGNS / SYMPTOMS
Depression resulting in reduced libido.
Psychogenic erectile dysfunction.
INVESTIGATIONS
With depression, hormonal tests may be normal.
Normal early morning erections will still occur if erectile dysfunction is psychogenic.
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