Case history
Case history #1
A 28-year-old woman presents with headaches for the past 9 months that have worsened recently. Review of systems is otherwise negative except for some irregularity in her menstruation over the past year. On physical examination she has no stigmata for Cushing syndrome or acromegaly. Her visual fields by confrontation are normal and she has had no galactorrhea.
Case history #2
A 52-year-old man presents with some difficulty driving at night and reports not seeing cars coming from the sides. He also describes progressive loss of libido and inability to obtain and maintain an erection, which started about 2 years ago. He reports bumping into things. He has gained about 11 lb (5 kg) in weight over the past 2 to 3 years. He has fatigue and is unable to do the same jobs that he used to do a year ago. The examination reveals moderate obesity (BMI 35) with some loss of muscle bulk over the proximal arm and leg muscle groups. Other positive findings include the presence of small bilateral gynecomastia, soft testicles (12 mL), and abnormal visual fields to confrontation, with bitemporal hemianopia.
Other presentations
Diplopia may be caused by nonadenomatous lesions, or sometimes by clinically nonfunctional pituitary adenomas (CNFPAs) via tumor extension into the cavernous sinuses.[8] Third nerve palsy is the most commonly associated cranial nerve palsy.[9] Facial pain and paresthesia from palsy of the V1 and V2 branches of the fifth cranial nerve may sometimes occur.[9] Pituitary tumors may extend superiorly into the third ventricle to cause hydrocephalus.[10]
There is typically a mild-to-moderate hyperprolactinemia (<100 nanograms/mL) associated with a disruption of the tonic hypothalamic dopamine inhibitory effect on the pituitary prolactin secretion, referred to as "stalk effect." Pituitary apoplexy may be the presenting clinical picture usually associated with severe headache and other symptoms associated with mass effect.[11][12] Seizures may very occasionally occur from temporal lobe involvement.[10][13] Rarely, gonadotroph adenomas may present with precocious puberty, high testosterone levels, or macro-orchidism in males or ovarian hyperstimulation in women.[1][14]
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