Pituitary gland tumor My friend's case-Need your valuable opinion

Chief complaint A 31-year-old male was diagnosed with Pituitary gland tumor. History He was having hair loss along with fatigue & lethargy 6 months back. He consulted a doctor who prescribed regular tests + testosterone test. He also complains of weight gain. Physical examination He is a healthy male with no other disease. Investigations All reports are attached with the case and rest in the comments. His consulting doctor has prescribed regular tests + testosterone test 6 months back. In which Testosterone level was low. He repeated the test after 6 months then the testosterone level was even lower so he consulted an endocrinologist who asked for MRI Brain. Then he was diagnosed with Pituitary gland tumor. The difference in cortical level in 2 reports is because 1 test was done empty stomach and the other test was done after having 1 tablet (He dont remember the name) at night and repeat the test in the morning. This is why there is a difference in the level of serum cortisol. Diagnosis Pituitary gland Tumor Treatment 1) Could this tumor show growth in the future? 2) Is surgery needed? 3) What is the treatment - Only hormonal therapy or other treatment for tumor also? 4) What is management for his weight gain? Please ask any question you need to ask and give your valuable opinion.

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Pituitary microadenoma Mostly benign More then 1 cm has to operate Functioning tumour better to Get operated Confirm with core biopsy HP

Thank you sir
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Pituitary adenoma can cause three types of damages 1) By secretion of hormones 2) By decreasing secretion of hormones 3) Pressure symptoms 1) By secretion of hormones - functioning pituitary adenoma can produce, ACTH hormone, TSH hormone, Growth hormone or Prolapse and there by manifest ill effect related to its increased production But in this case, the pituitary microadenoma appears to be nonfunctional, therefore not causing any increased hormone related effects 2) Decreased functioning of hormone, pituitary adenoma can compress on normal functioning cells and can cause decreased formation of normally hormone. In this case particularly gonadotrophic hormone because this patient has low testosterone level. However, this patient has normal FSH and LH, normal gonadotrophic hormone. So he do not have any decreased functioning of normal hormone producing cells 3) Pressure symptoms - Pituitary adenoma can cause damage by pressure of optic chiasma and can cause partial blindness - bitemporal hemianopia. Which apparently this patient do not have. However this patients visual field check up need to be carried out to confirm that he do not have bitemporal hemianopia. Considering that this patient do not have any ill effect related to microadenoma of pituitary gland, there is no need to do any active intervention as stated by many other experts. Regular follow up testing if necessary to watch for increase in size and appearances of new symptoms

Thanks alot sir
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Repected Dr Chauhan - I will answer your queries one by one 1.It is a case of pituitary microedenoma - It may grow in future 2.No - Surgery is not needed 3 Only hormonal treatment is required 4.Weight gain can be due to multiple factors. Sedentary life style Excessive carbohydrate and fat containing diet Effects of hormonal therapy As cortisol level is normal although on the higher side it means - no treatment is required for it As S.Prolactin is normal - no treatment is required. Similarly FSH , LH and GH are normal . As the microedenoma is,less than 1 cm - No Indication of surgery . A regular MRI scan after an year interval to see if its size increases to more than 1 cm - oy then surgery is required. Also it patient develops - Cushings syndrome - surgery is indicated... Investigate for other causes of fatigue and lethargy like DM , hypothyroidism , liver disease etc . Mean while- refer the patient to an Endocrinologist for further follow up for non - surgical treatment

Thanks alot sir for your reply
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Pituitary microadenoma... It is a pituitary adenoma (tumor) that is smaller than 1 centimeter. These tumors form on the pituitary gland and are the most common form of pituitary tumor. Pituitary microadenomas develop when DNA mutations cause cells in the pituitary gland grow and divide uncontrollably. Adenomas remain in your pituitary gland or surrounding tissues and don't spread to other parts of your body. Pituitary tumors that make hormones (functioning) can cause a variety of signs and symptoms depending on the hormone they produce If it's ACTH tumor cN cause Cushing Syndrome.. If it's G@@rowth hormone tumor, it can cause Acromegaly. If it's Prolactoma...It can cause decrease sex hormones.

Thank you sir. His doctor asked him to preserve sperms as hormonal therapy may effect that. Sir he is not married yet, should he go for that and is there any other side effect of Hormonal therapy for him.
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When we were undergraduates we saw pituitary forceps. It was apparently inserted in the nose to the base of skull to remove pituitary gland or tumors. Is it still in use? Frontal lobotomy is carried out by similarly driving a sharp instrument in to brain. Sounds gruesome. Today I think stereotactic surgery is used. Can you elaborate? Our knowledge is rudimentary.

Thanks sir
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Incidentaloma. No interference needed. Testosterone level marginally reduced. Does not require hormone therapy

At present only follow up with MRI.. With Hormonal therapy with Endocrinologist..

Thank you sir
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Benign micro ademona No need of surgery right now.

Thank you sir
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surgery

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