Pituitary Gland Thyrotoxicosis Adrenal Gland Thyroid/Parathyroid Bone Health Skin + Heart $100 $100 $100 $100 $100 $200 $200 $200 $200 $200 $300 $300 $300 $300 $300 $400 $400 $400 $400 $400 $500 $500 $500 $500 $500

Pituitary $200-56 year old male with loss of libido, testosterone 40 mg/dL, and prolactin 65 mg/dL (Normal <20) Visual Fields

Bitemporal Hemianopsia? What is Bitemporal Hemianopsia?

Bitemporal Hemianopsia In bitemporal hemianopsia vision is missing in the outer (temporal or lateral) half of both the right and left visual fields. Information from the temporal visual field falls on the nasal (medial) retina. The nasal retina is responsible for carrying the information along the optic nerve, and crosses to the other side at the optic chiasm. When there is compression at optic chiasm the visual impulse from both nasal retina are affected, leading to inability to view the temporal, or peripheral, vision. This phenomenon is known as bitemporal hemianopsia. Knowing the neurocircuitry of visual signal flow through the optic tract is very important in understanding bitemporal hemianopsia. Bitemporal hemianopsia most commonly occurs as a result of tumors located at the mid-optic chiasm. Since the adjacent structure is the pituitary gland, some common tumors causing compression are pituitary adenomas and craniopharyngiomas. Also another relatively common neoplastic etiology is meningiomas. An etiology of vascular origin is an aneurysm of the anterior communicating artery which arise superior to the chiasm, enlarge, and compress it from above.

MRI Pituitary 2.8 cm Macroadenoma This radiograph (of an MRI) demonstrates a pituitary macroadenoma (classic "snowman" appearance circled by a radiologist) on coronal view extending outside of the bony sella turcica and displacing the optic nerve (which is bowed around the tumor).

Pituitary Macroadenoma “Snowman” Pituitary Macroadenoma

Etiology of Hyperprolactinemia Physiological: coitus, exercise, lactation, pregnancy, sleep, stress, breast stimulation Pharmacological: anesthetics, anticonvulsants, antidepressants, antihistamines (H2), anti-hypertensives, neuropeptides, cholinergic agonists, dopamine receptor blockers, estrogens/BCP’S, dopamine synthesis inhibitor, neuroleptics/antipsychotics, opiates/opiate antagonists Pathological Hypothalamic-pituitary stalk damage: granulomas, infiltrations, irradiation, Rathke’s cyst, trauma, tumors (craniopharyngioma, germinoma, hypothalamic metastases, meningioma, suprasellar pituitary mass extension) Pituitary: acromegaly, prolactinoma, macroadenoma (compressive), lymphocytic hypophysitis or parasellar mass Systemic disorders: neurogenic chest wall trauma, surgery, herpes zoster, chronic renal failure, cirrhosis, cranial radiation, epileptic seizures, polycystic ovarian disease, pseudocyesis

Hyperprolactinemia Evaluation