Pituitary Disease

Who to refer:

• Patients with an incidental diagnosis of a pituitary adenoma
  • These patients do not necessarily need surgery and should be evaluated by an endocrinologist prior to neurosurgical referral
• At the time of referral, please check the following (although there is no need to wait for the results before sending in the referral):
  • Prolactin
  • Thyroid function
  • Gonadotrophins and testosterone in males
  • Gonadotrophins and oestradiol in females only if amenorrhoeic
• Patients requiring urgent endocrine assessment:

• Patients with visual field defect
• Patients with any suggestion of ACTH/glucocorticoid deficiency (hypotension, hyponatraemia, significant lethargy)
• Patients with galactorrhoea

• Check prolactin and thyroid function
• Exclude iatrogenic causes such as antiemetics, antidepressants, antipsychotic medication
• Patients with clinical features of acromegaly
• Patients with features of Cushing’s syndrome not explained by steroid therapy
• Patients with a past history of irradiation including the pituitary and those with hypopituitarism on hormone replacement therapy. 
  • These patients usually require lifelong follow-up
  • Please re-refer if they have been lost to follow-up or have transferred here from another region.
  • Growth Hormone replacement and somatostatin analogue therapy are managed under shared care protocols (see resources and links for information)

Who not to refer

We are happy to review all patients with pituitary disease in the endocrine clinic

Pituitary disease is a broad and potentially complex area which should be investigated and managed in secondary care. If steps should be taken in primary care prior to the patient’s attendance at clinic, consultants will be able to advise when triaging the referral. Do not hesitate to contact us using the ‘advice only’ option with any queries Most pituitary investigations should happen in secondary care.  Specifically, patients should not have a pituitary MRI requested until there is a firm biochemical diagnosis – MRI’s will be arranged from secondary care. However, if the patient is being referred because of the incidental finding of a pituitary mass on imaging undertaken for another reason, please check the following blood tests (there is no need to wait for the results before sending in the referral):

• Prolactin
• Thyroid function
• Gonadotrophins and testosterone in males
• Gonadotrophins and oestradiol in females only if amenorrhoeic

If a patient has secondary hypothyroidism (ie hypothyroidism secondary to pituitary disease and TSH deficiency) please do not commence levothyroxine until the patient has been assessed or at least discussed with secondary care.  If the patient also has co-existing ACTH deficiency, an Addisonian crisis can be precipitated if levothyroxine is commenced before the patient is established on hydrocortisione.

Please see the Lothian Joint Formulary Shared Care Agreements section for details of Growth Hormone and somatostatin analogue prescribing.

Patient information is available on the following website:

https://www.pituitary.org.uk/