9: Pituitary disease in adults

DESPITE SIGNIFICANT ADVANCES in the biochemical eval- uation of pituitary function, diagnosis of pituitary disorders is often delayed by lack of awareness of these conditions and the subtlety of their symptoms and signs. In this article we focus on practical clinical aspects and areas in which there have been significant recent developments. Adrenal disor- ders related to pituitary disease are also considered. Recent developments include the wider availability of high quality magnetic resonance imaging, recognition of "incidentalo- mas" and the important role of growth hormone in adults, development of new therapies for acromegaly and prolac- tinoma, and improved diagnostic methods for Cushing's syndrome. Epidemiology While pituitary disorders are considered uncommon, pitui- tary adenomas are found in 10%-25% of unselected autopsy series, 1 and magnetic resonance imaging reveals pituitary lesions in about 10% of normal individuals. 2 The reasons for this discrepancy are not clear. With the advent of high-resolution cranial imaging, unsuspected and often clinically significant pituitary lesions are commonly discov- ered during investigation of unrelated conditions. ABSTRACT ■ Pituitary adenomas are found in 10%-25% of unselected autopsy series and are evident in about 10% of asymptomatic individuals by magnetic resonance imaging.