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Presentation of pituitary tumours

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Pituitary tumours may present because of either their mass their or endocrine effects.

Mass effects are usually due to large tumours and include:

  • headache - non-specific
  • visual field defects - from pressure on the inferior of the optic chiasm; begins as a superior temporal quadrantanopia progressing to bitemporal hemianopia
  • cavernous sinus compression - resulting from lateral extension of the tumour into the cavernous sinus. Most often produces a III nerve palsy; may also compress the IV and VI nerves, and produce sensory loss in the first and second divisions of cranial V.
  • rarely, erosion of the mass through the sphenoid sinus produces a CSF rhinorrhoea

Endocrine effects may be due to oversecretion of specific hormones, usually one, especially caused by small tumours:

  • hyperprolactinaemia - most common
  • gigantism / acromegaly - from GH hypersecretion
  • Cushing's disease - from ACTH hypersecretion - presents as Cushing's syndrome
  • rarely, hypersecretion of TSH, FSH, LH

Or due to undersecretion of specific hormones, presenting as panhypopituitarism. This may be associated with compression of the pituitary gland from a large tumour, or may result from small tumours.

Pituitary adenomas may also present as pituitary apoplexy.

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