Disease Description (Causes and Symptoms)
- Disease name confirmation: "Hyperfunction of pituitary gland (hyperpituitarism, hyperfunction of the pituitary gland)" is a broad medical term. Depending on the type of hormone secreted in excess, it is subdivided into acromegaly/gigantism (excess GH), hyperprolactinemia (prolactin), Cushing disease (excess ACTH), TSH-secreting tumors, and others.
- Causes and pathophysiology
- In most cases, a functional pituitary adenoma (usually a benign adenoma) excessively secretes hormones. Rarely, secondary hypersecretion may occur due to ectopic ACTH-secreting tumors outside the pituitary or other causes.
- As the tumor grows, it may compress the optic nerve, causing visual field defects and headaches, or cause hypofunction (hypopituitarism) due to compression of the normal pituitary gland.
- Main symptoms (representative symptoms according to the hormone involved)
- Excess GH: gigantism in children; acromegaly in adults (enlargement of the hands, feet, and face, joint pain, carpal tunnel syndrome); increased sweating, fatigue, diabetes, and cardiovascular risk
- Excess prolactin: milk discharge (galactorrhea), amenorrhea and infertility (women), decreased libido and erectile dysfunction (men)
- Excess ACTH (Cushing disease): central obesity, round face (moon face), skin thinning, easy bruising, muscle weakness, hypertension, hyperglycemia, and osteoporosis
- TSH-secreting adenoma: symptoms of hyperthyroidism (palpitations, weight loss, tremor)
- Common: headaches, visual field defects (bitemporal hemianopia), excessive sweating, fatigue, insomnia, and others
Treatment Methods
- Principle: Individualized treatment is determined according to the excessively secreted hormone, tumor size (microadenoma vs. macroadenoma), and presence or absence of optic nerve compression.
- Medication
- Prolactinoma: dopamine agonists (cabergoline is the first-line choice; bromocriptine is an alternative) — effective for tumor shrinkage and normalization of prolactin.
- Excess GH (when surgery is not possible or residual disease remains): somatostatin analogs (octreotide, lanreotide), GH receptor antagonist (pegvisomant).
- Adjunctive medications for Cushing disease: adrenal steroid synthesis inhibitors such as ketoconazole, metyrapone, and osilodrostat (for systemic management).
- Surgery
- Endoscopic transsphenoidal surgery: first-line treatment when there is optic nerve compression or a high likelihood of cure with surgery. It is the standard first-line treatment for most functional adenomas.
- Transcranial approach: selectively used for very large tumors or atypical extension.
- Radiation therapy
- Gamma Knife (stereotactic radiation) or external-beam radiation therapy may be considered when the condition cannot be controlled with surgery and medication or when residual tumor remains.
- Complication management and hormone replacement
- Appropriate hormone replacement is necessary in cases of temporary or persistent postoperative hypopituitarism (adrenal, thyroid, or gonadal insufficiency).
- Monitoring for optic nerve recovery and concurrent medical treatment for diabetes, hypertension, and osteoporosis.
- Lifestyle management and precautions
- Monitor medication-specific adverse effects: cabergoline (dizziness, nausea, rarely valvular heart abnormalities), somatostatin analogs (gastrointestinal symptoms, gallstones), pegvisomant (abnormal liver function), and others.
- Pay attention to nasal and sinus infections before and after surgery, and monitor for postoperative diabetes insipidus (CDI) and cerebrospinal fluid leakage from the surgical site (CSF leak).
- If pregnancy is planned, prior consultation with the treating physician is necessary regarding prolactinoma management (dopamine agonist dose adjustment and whether to discontinue the medication).
Outpatient Visit Checklist (Including What to Bring and Example Questions)
- What to bring
- A list of all currently taken medications and dietary supplements (including dosage and administration times)
- Previous test results (blood tests, hormone tests, MRI/CT films or CDs), and surgical or hospitalization records
- A record of the timeline of symptom changes (when they started and factors that worsened or improved them)
- Home blood pressure and blood glucose records (if available)
- For women, the date of the last menstrual period, pregnancy status, and breastfeeding status
- Key information to tell the doctor during the outpatient visit (including example questions)
- Are there visual field defects (bilateral temporal visual field loss), sudden visual deterioration, or severe headaches?
- Is there milk discharge, irregular menstruation, changes in libido, or erectile dysfunction?
- Has the size of the hands or feet changed, or have shoe or ring sizes increased?
- Regarding currently taken medications: "Do I need to stop any of the medications I am taking?"
- Precautions before testing: whether fasting is required, medications that should be stopped (e.g., medications related to dopamine agonist testing), and others
Examples of General Questions to Ask the Doctor
- What tests are used to confirm this tumor (or hormone excess)? What additional tests are needed?
- What is the recommended first-line treatment, and what are its expected effects and risks (adverse effects)?
- How will long-term follow-up be conducted after treatment, and how often will testing be performed?
- What are the major adverse effects of the medication I am currently taking, and how should I respond if they occur?
- If I am planning a pregnancy, what is the treatment and medication management plan?
Examples of Disease-Specific Questions
- Regarding excess prolactin: "If my prolactin level returns to normal, is it okay to stop the medication? If I am planning a pregnancy, how should I adjust my medication?"
- Regarding excess GH/acromegaly: "If my GH and IGF-1 levels do not return to normal after surgery, what additional medications will be needed? How should joint pain and cardiovascular risk be managed?"