Subjective
Date of visit
Reason for visit (initial presentation, follow-up for pituitary carcinoma)
History of present illness:
Symptoms suggestive of hormone excess or deficiency (depending on the affected hormone):
Pituitary mass effects (headaches, vision changes)
Growth hormone excess (acromegaly):
Coarsening of facial features
Enlarged hands and feet
Carpal tunnel syndrome
Sweating
Growth hormone deficiency:
Fatigue
Decreased energy levels
Weakness
Weight gain or difficulty losing weight
Prolactin excess (galactorrhea – milky nipple discharge)
ACTH (adrenocorticotropic hormone) excess (Cushing’s disease):
Weight gain (central obesity)
Easy bruising
Moon facies (round face)
Stretch marks
Thyroid stimulating hormone (TSH) excess or deficiency (symptoms of hyperthyroidism or hypothyroidism)
Duration of symptoms
Past medical history (relevant conditions, previous surgeries)
Medications (current medications, hormone replacement therapy)
Allergies
Objective
Vital signs (temperature, heart rate, blood pressure)
Physical exam:
General (signs of Cushing’s disease or acromegaly)
Neurological exam (assess for visual field defects due to mass effect)
Visual acuity testing
Assessment
Pituitary carcinoma (suspected based on clinical presentation and imaging studies)
Type of hormone excess or deficiency (based on clinical features and hormone testing)
Tumor size and extension (invasive vs. non-invasive)
Sellar mass effect (compression of surrounding structures)
Consider differential diagnoses (pituitary adenoma with atypical features)
Plan
Imaging studies:
Pituitary MRI with contrast (to assess tumor size, location, and invasion)
CT scan (may be helpful for bony erosion)
Hormonal testing:
Assess specific hormone levels based on clinical suspicion (growth hormone, prolactin, ACTH, TSH, free T4)
Visual field testing (may be repeated during follow-up)
Treatment options (multimodal approach is often needed):
Surgery (transcranial or transsphenoidal) – aimed for gross total resection if feasible
Radiation therapy (stereotactic radiosurgery or conventional radiotherapy)
Medications:
Hormone replacement therapy (to address hormone deficiencies)
Dopamine agonists (for prolactinomas)
Somatostatin analogs (for growth hormone excess)
Mifepristone (for Cushing’s disease)
Consultation with an endocrinologist, neurosurgeon, and radiation oncologist for a multidisciplinary treatment plan.
Education
Explain the diagnosis, pituitary hormone functions, and potential consequences of hormone imbalances.
Discuss the treatment plan, potential risks and benefits of each modality.
Importance of medication adherence for hormone replacement therapy.
Support resources and patient advocacy groups (if applicable)
Follow-up
Schedule for frequent follow-up appointments:
Monitor hormone levels and clinical symptoms
Repeat imaging studies (MRI) to assess response to treatment
Address any treatment-related side effects
Consider long-term surveillance for tumor recurrence
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of pituitary carcinoma.