Pituitary hormone excess

Keywords: Hyperprolactinaemia

Causes

Appropriate Tests

 

Increased levels of pituitary hormones may be the result of autonomous production by pituitary adenomas, release from inhibitory feedback mechanisms, or ectopic secretion.

One or more hormones may be increased and if there is a pituitary lesion, there may be associated deficiency of one or more hormones.

See also Pituitary/hypothalamic disorders.

ADH excess

See SIADH

Growth hormone excess

Acromegaly, gigantism (in childhood).

IGF-1; Growth hormone suppression test.

Pituitary adenoma

 

Ectopic syndromes (rare)

 

Pancreatic islet cell tumour

See under Pancreatic neoplasm

Carcinoid tumour (lungs, adrenals)

 

Adrenocorticotrophin excess

Dexamethasone suppression test-overnight; Cortisol urine.

Then, if indicated, Dexamethasone suppression test-long including ACTH.

See Cushing's syndrome

Pituitary adenoma

Cushing's disease.

Clinical features of Cushing's syndrome.

Ectopic ACTH syndrome

Patients may have clinical features of Cushing's syndrome.

Nelson's syndrome

Patients are not Cushingoid. ACTH is the appropriate test.

Prolactin excess

Present with amenorrhoea and/or galactorrhoea.

Prolactin; repeat, if elevated, to document persistent elevation.

See also Infertility (male and female)

Prolactinoma

 

Other pituitary tumour

 

Physiological

  • Post-oral contraceptive use
  • Stress

 

Drugs, especially

  • Cimetidine
  • Methadone
  • Metoclopramide

 

Thyrotrophin excess

'Pituitary' Hyperthyroidism: Thyroid stimulating hormone, Free T4.

See Hyperthyroidism

Pituitary adenoma

 

Pituitary T4 resistance

 

Gonadotrophin excess

Precocious puberty, Gynaecomastia. In many cases, there are no clinical features suggesting an endocrine disorder.

Luteinising hormone, Follicle stimulating hormone, Alpha subunit, Testosterone or Oestradiol.

Pituitary adenoma

 

Ectopic syndromes, especially

  • Germinoma
  • Carcinoma lung
  • Hepatocellular carcinoma

Beta HCG quantitation.

Alpha subunit excess

These patients do not present with clinical features of an endocrine disorder: Alpha subunit.

Alpha subunit secreting tumours