Non functioning pituitary adenoma
Clinically non functioning pituitary tumours may be null cell adenomas or have positive staining for other peptides but with no clinically detectable sequelae. Diagnosis requires MRI scanning and assessment of pituitary function.
General examination
To diagnose non functioning pituitary adenoma a detailed and full general examination is mandatory in the initial assessment of a patient.
Blood pressure
A postural drop in BP may be found in glucocorticoid deficiency.
Breast or testicular examination
This should be performed in all patients presenting with an apparently isolated pituitary mass due to the possibility of metastatic disease.
Thyroid
This should be performed in all patients presenting with an apparently isolated pituitary mass due to the possibility of metastatic disease.
Digital rectal examination
Consider performing this in all patients presenting with an apparently isolated pituitary mass due to the possibility of metastatic disease.
Pituitary status
Visual acuity and visual fields
Full assessment of acuity and fields is mandatory in all patients suspected of pituitary disease to detect chiasmal compression or other involvement of the optic pathways.
Visual fundoscopy
Disc pallor is indicative of long term visual loss which may not recover after decompression of the optic pathway.
Papilloedema is an indicator of raised intracranial pressure requiring urgent investigation.
Cranial nerves III-XII
Full cranial nerve assessment is important in all patients with suspected pituitary tumours.
The nerves of the cavernous sinus are most frequently affected, though a VI nerve palsy may be a false localising sign associated with increased intracranial pressure.
Skin
Fine wrinkling of the skin occurs in hypopituitarism.
Pallor may also occur with a normocytic normochromic anaemia with glucocorticoid deficiency.
Doughy, pallid, 'myxoedematous' skin may be seen with loss of thyroid function.
Doughy skin with soft tissue swelling also occurs in growth hormone excess.
Café au lait patches, skin tags and axillary freckling may indicate associated syndromes, for example multiple endocrine neoplasia 2, neurofibromatosis or McCune Albright syndrome.
Breast examination
Breasts should be examined for swelling or galactorrhoea with hyperprolactinaemia.
Thyroid status
Specifically seek signs of thyroid dysfunction.
Musculature
Muscle wasting may occur in glucocorticoid deficiency. Proximal myopathy and slow relaxing reflexes may occur with loss of thyroid function.