{"id":4308,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/pituitarydisease\/"},"modified":"2023-08-30T09:56:00","modified_gmt":"2023-08-30T08:56:00","slug":"pituitarydisease","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/endocrinology\/pituitarydisease\/","title":{"rendered":"Pituitary Disease"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\"><strong><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">This Section\/Page is&nbsp;currently undergoing the RefHelp review&nbsp;process (Dec 18) and will&nbsp;be finalised&nbsp;in&nbsp;2019<\/mark><\/strong><a rel=\"noreferrer noopener\" href=\"http:\/\/www.refhelp.scot.nhs.uk\/index.php?option=com_content&amp;view=article&amp;id=957&amp;Itemid=1557\" target=\"_blank\"><\/a><\/strong><\/h4>\n\n\n\n<h3 class=\"wp-block-heading\">Information<\/h3>\n\n\n\n<p>Patients with suspected pituitary disease can be referred to the general endocrine clinics at RIE, WGH or SJH.<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Who to refer:<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Patients with an incidental diagnosis of a pituitary adenoma<\/strong>\n<ul class=\"wp-block-list\">\n<li>These patients do not necessarily need surgery and should be evaluated by an endocrinologist prior to neurosurgical referral<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>At the time of referral, please check the following (although there is no need to wait for the results before sending in the referral):\n<ul class=\"wp-block-list\">\n<li>Prolactin<\/li>\n\n\n\n<li>Thyroid function<\/li>\n\n\n\n<li>Gonadotrophins and testosterone in males<\/li>\n\n\n\n<li>Gonadotrophins and oestradiol in females&nbsp;<strong>only if amenorrhoeic<\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Patients requiring urgent endocrine assessment:<\/strong><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with visual field defect<\/li>\n\n\n\n<li>Patients with any suggestion of ACTH\/glucocorticoid deficiency (hypotension, hyponatraemia, significant lethargy)<\/li>\n\n\n\n<li><strong>Patients with galactorrhoea<\/strong><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Check prolactin and thyroid function<\/li>\n\n\n\n<li>Exclude iatrogenic causes such as antiemetics, antidepressants<strong>,&nbsp;<\/strong>antipsychotic medication<\/li>\n\n\n\n<li><strong>Patients with clinical features of acromegaly<\/strong><\/li>\n\n\n\n<li><strong>Patients with features of Cushing&#8217;s syndrome not explained by steroid therapy<\/strong><\/li>\n\n\n\n<li><strong>Patients with a past history of irradiation including the pituitary and those with hypopituitarism on hormone replacement therapy.&nbsp;<\/strong>\n<ul class=\"wp-block-list\">\n<li>These patients usually require lifelong follow-up<\/li>\n\n\n\n<li>Please re-refer if they have been lost to follow-up or have transferred here from another region.<\/li>\n\n\n\n<li>Growth Hormone replacement and somatostatin analogue therapy are managed under shared care protocols (see resources and links for information)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Who not to refer<\/h3>\n\n\n\n<p>We are happy to review all patients with pituitary disease in the endocrine clinic<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>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&#8217;s attendance at clinic, consultants will be able to advise when triaging the referral. Do not hesitate to contact us using the &#8216;advice only&#8217; option with any queries Most pituitary investigations should happen in secondary care.&nbsp; Specifically, patients should&nbsp;<strong>not<\/strong>&nbsp;have a pituitary MRI requested until there is a firm biochemical diagnosis \u2013 MRI&#8217;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):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Prolactin<\/li>\n\n\n\n<li>Thyroid function<\/li>\n\n\n\n<li>Gonadotrophins and testosterone in males<\/li>\n\n\n\n<li>Gonadotrophins and oestradiol in females&nbsp;<strong>only if amenorrhoeic<\/strong><\/li>\n<\/ul>\n\n\n\n<p>If a patient has secondary hypothyroidism (ie hypothyroidism secondary to pituitary disease and TSH deficiency) please do&nbsp;<strong>not<\/strong>&nbsp;commence levothyroxine until the patient has been assessed or at least discussed with secondary care.&nbsp; 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.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><em>Please see the <\/em><a href=\"https:\/\/formulary.nhs.scot\/east\">Lothian Joint Formulary<\/a><em> Shared Care Agreements section for details of Growth Hormone and somatostatin analogue prescribing.<\/em><\/p>\n\n\n\n<p>Patient information is available on the following website:<\/p>\n\n\n\n<p><a href=\"https:\/\/www.pituitary.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.pituitary.org.uk\/<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This Section\/Page is&nbsp;currently undergoing the RefHelp review&nbsp;process (Dec 18) and will&nbsp;be finalised&nbsp;in&nbsp;2019 Information Patients with suspected pituitary disease can be referred to the general endocrine clinics at RIE, WGH or SJH.<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3908,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[130],"class_list":["post-4308","page","type-page","status-publish","hentry","category-pituitarydisease"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/endocrinology\/pituitarydisease\/\" rel=\"tag\">Pituitary Disease<\/a>","rttpg_excerpt":"This Section\/Page is&nbsp;currently undergoing the RefHelp review&nbsp;process (Dec 18) and will&nbsp;be finalised&nbsp;in&nbsp;2019 Information Patients with suspected pituitary disease can be referred to the general endocrine clinics at RIE, WGH or SJH.","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4308","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4308"}],"version-history":[{"count":4,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4308\/revisions"}],"predecessor-version":[{"id":14019,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4308\/revisions\/14019"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3908"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4308"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4308"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}