Diagnosis and surgical treatment of pituitary lesions

The primary care physician has a critical role in the recognition and early screening of pituitary lesions. Often the symptoms are nonspecific--headache, fatigue, and weakness. With menstrual irregularity, visual field loss, growth abnormality, or changes in body habitus or appearance, however, further investigation is needed. A single lateral skull X-ray may be enough to indicate pathology and warrant endocrine referral. If doubt exists even with a normal skull film, endocrine evaluation is worth undertaking. With increasing selectivity and safety of neurosurgical procedures, and with the help of physicians and radiotherapists, the neurosurgeon is able to offer the patient with a pituitary tumor a good chance of cure with minimal morbidity. However, the surgeon must often depend on the primary care physician to discover new visual field loss or endocrine changes that may signal recurrence, as well as to suspect the diagnosis of a pituitary lesion. The diagnosis, treatment, and follow-up of these lesions is best handled by an interdisciplinary team of physicians.