Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
(Varies depending on the presenting hormone deficiencies)
Fatigue
Weakness
Headache (may be chronic or worsening)
Visual disturbances (if adenoma presses on optic nerves)
Amenorrhea (absence of menstrual periods) in females
Galactorrhea (milk production from breasts outside of pregnancy or
breastfeeding)
Decreased libido
Cold intolerance
Difficulty concentrating or memory problems (less common)
History of Present Illness:
Onset, duration, and severity of symptoms.
Specific details of any presenting symptoms (e.g., frequency of headaches,
character of visual disturbances).
Prior surgeries or procedures (e.g., pituitary surgery).
Past Medical History:
Underlying medical conditions (e.g., hypertension, diabetes).
Prior diagnoses of hormonal deficiencies (e.g., hypothyroidism,
hypogonadism).
Family History:
Family history of pituitary tumors (rare).
Social History:
Not typically relevant for nonfunctioning pituitary adenoma unless symptoms
affect work or daily activities.
Physical Exam:
General examination: Assess for signs of hormone deficiencies (e.g.,
Pale skin (anemia)
Dry skin and hair (hypothyroidism)
Weight gain or loss (can occur with various hormone deficiencies)
Gynecomastia (breast enlargement in males) with hypogonadism)
Visual field assessment: To detect potential visual field defects
suggestive of optic nerve compression.
Laboratory Tests:
Complete blood count (CBC): May show anemia with chronic illness.
Serum electrolytes: May be abnormal with specific hormone deficiencies
(e.g., low sodium with hypopituitarism).
Hormonal evaluation: Blood tests to assess pituitary hormone function
(typically includes):
Thyroid-stimulating hormone (TSH) and free thyroxine (fT4) for
thyroid function
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) for
gonadal function
Prolactin level (elevated in some cases of nonfunctioning adenomas)
Adrenocorticotropic hormone (ACTH) and cortisol level for adrenal
function
Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) level
(may be low but not routinely measured)
Imaging Studies:
Magnetic resonance imaging (MRI) of the brain with pituitary protocol:
Gold standard for visualizing the pituitary gland and identifying adenomas.
MRI can assess the size, location, and characteristics of the tumor.
Assessment:
Nonfunctioning pituitary adenoma: Based on clinical presentation
(symptoms suggestive of hormone deficiencies) and imaging findings (MRI
demonstrating a pituitary mass).
Specific hormone deficiencies: Hormonal evaluation results will identify
which pituitary hormones are not being produced in sufficient amounts (e.g.,
hypopituitarism with growth hormone and ACTH deficiency).
Size and location of the adenoma: Determined by MRI. Larger
adenomas may cause symptoms due to mass effect (compressing surrounding structures).
Differential Diagnoses:
Consider other causes of symptoms:
Primary hormone deficiencies (e.g., primary hypothyroidism)
Empty sella syndrome (collapsed pituitary fossa without a tumor)
Other intracranial tumors
Plan:
The treatment plan for nonfunctioning pituitary adenomas depends on several
factors including:
Size and location of the adenoma
Presence and severity of hormone deficiencies
Patient’s symptoms and overall health
Treatment options may include:
Observation: For small, non-aggressive tumors and no significant
hormone deficiencies, monitoring with regular exams and hormonal testing
may be sufficient.
Surgery: Transsphenoidal surgery (through the nose) is the preferred
treatment for symptomatic or large adenomas. Surgery aims to remove the
adenoma and restore pituitary function.