Assessment of pituitary mass

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Elevated urinary cortisol (triple the upper limit of normal for the assay) along with high-normal or elevated ACTH level confirms the diagnosis in most cases.

Elevated urinary cortisol (triple the upper limit of normal for the assay) along with high-normal or elevated ACTH level confirms the diagnosis in most cases.

Patients should be given 1 mg of dexamethasone at 11 p.m. Plasma cortisol level is obtained the following day at 8 a.m. Dexamethasone levels are measured simultaneously with cortisol to ensure that appropriate levels are achieved.

Patients should be given 2 mg of dexamethasone at 6-hour intervals for 48 hours or as an overnight test using a single dose of 8 mg of dexamethasone at 11 p.m. Plasma cortisol should be obtained at the start of the test and on the following morning. Positive test is suppression of cortisol <50% of baseline value. Positive test suggests a pituitary source of ACTH over-secretion.

Blood is sampled peripherally and in the inferior petrosal sinuses (centrally) simultaneously.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Result must be interpreted with age- and sex-normative data. Serum concentrations are highest during puberty and decline progressively from then on.

A normal IGF-1 level effectively excludes the diagnosis.[39]Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014 Oct 30;99(11):3933-51. https://academic.oup.com/jcem/article/99/11/3933/2836347 http://www.ncbi.nlm.nih.gov/pubmed/25356808?tool=bestpractice.com

Standard method to confirm the diagnosis of acromegaly.

Serum GH levels are measured at 30-minute intervals for 2 hours after ingestion of 75 g of glucose.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, and adrenocorticotropic hormone should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Result must be interpreted with age- and sex-normative data. Serum concentrations are highest during puberty and decline progressively from then on.

A normal IGF-1 level effectively excludes the diagnosis.[39]Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014 Oct 30;99(11):3933-51. https://academic.oup.com/jcem/article/99/11/3933/2836347 http://www.ncbi.nlm.nih.gov/pubmed/25356808?tool=bestpractice.com

Standard method to confirm the diagnosis of acromegaly.

Serum GH levels are measured at 30-minute intervals for 2 hours after ingestion of 75 g of glucose.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Patients should be given 1 mg of dexamethasone at 11 p.m. Plasma cortisol level is obtained the following day at 8 a.m. Dexamethasone levels are measured simultaneously with cortisol to ensure that the appropriate levels are achieved.

Patients should be given 2 mg of dexamethasone at 6-hour intervals for 48 hours or as an overnight test using a single dose of 8 mg of dexamethasone at 11 p.m. Plasma cortisol should be obtained at the start of the test and the following morning. A positive test is defined as suppression of cortisol <50% of baseline value. A positive test suggests a pituitary source of adrenocorticotropic hormone over-secretion.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

A normal MRI scan does not rule out the diagnosis.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects, or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thryoid-stimulating factor, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.

Considered in any patient presenting with visual-field defects or where imaging reveals a lesion close to the optic chiasm.

Co-existing hypopituitarism should be assessed to identify and replace any hormone deficiency. Initially, baseline insulin-like growth factor 1, prolactin, thyroid-stimulating hormone, free T4, cortisol, adrenocorticotropic hormone, luteinising hormone, follicle-stimulating hormone, testosterone, and estradiol should be tested. Dynamic testing of pituitary hormone function may rarely be needed in some situations. If the history suggests diabetes insipidus, paired serum and urine osmolalities and serum electrolytes should be measured.