1. Pituitary Gland
Thyrotoxicosis
Adrenal Gland
Thyroid/Parathyroid
Bone Health
Skin + Heart
$100
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2. Pituitary $200-56 year old male with
loss of libido, testosterone 40 mg/dL, and
prolactin 65 mg/dL (Normal <20)
Visual Fields

3. Bitemporal Hemianopsia?
What is
Bitemporal Hemianopsia?

4. 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.

5. 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).

6. Pituitary Macroadenoma
“Snowman”
Pituitary Macroadenoma

7. 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

8. Hyperprolactinemia Evaluation