Pituitary Patient Resource Guide Sixth Edition Additional Information and References


By Lewis Blevins, M.D.

Chairman’s Foreword – Welcome to the Future
By Robert Knutzen, M.B.A., Chairman, PNA

By Sharmyn McGraw, Pituitary Patient

The Powerful Patient: How to Rise Above Adversity
By Robert Knutzen, MBA and Annie Hamilton

How Patients Can Help Prevent Misdiagnosis
By Tammy Mazzella, PNA

Board of Directors

Scientific Advisory Board

PNA Mission Statement


Chapter One: Types of Pituitary Disorders and their Manifestations

Introduction to Pituitary Disorders: Pituitary Tumors and Hypopituitarism
Daniel F. Kelly, M.D., Garni Barkhoudarian, M.D., and Pejman Cohan, M.D.

Acromegaly – GH-Secreting Adenoma
Adult Growth Hormone Deficiency
Antidiuretic Hormone Deficiency Causing Diabetes Insipidus
Cushing’s Syndrome and Cushing’s Disease – ACTH Secreting Adenoma
Deficiency of ACTH and Cortisol
Deficiency of LH and FSH (Hypogonadotropic Hypogonadism)
Empty Sella Syndrome
Endocrine-Inactive (i.e., Non-Functional) Adenoma
Rathke’s Cleft Cyst
Thyroid Hormone Deficiency (Hypothyroidism)
TSH (Thyroid Stimulating Hormone) Secreting Tumor

The Prevalence of Pituitary Adenomas: A Systematic Review
By Shereen Ezzat, M.D., Sylvia L. Asa, M.D., Ph.D. William T. Couldwell, M.D., Charles E. Barr, M.D., M.P.H., William E. Dodge, M.S., M.B.A., Mary Lee Vance, M.D. , and Ian E. McCutcheon, M.D.


  • 1. Asa SL. Tumors of the pituitary gland. In: Rosai J, editor. Atlas of tumor pathology. 3rd series Fascicle 22. Washington, DC: Armed Forces Institute of Pathology, 1998:1–214.
  • 2. Asa SL, Ezzat S. The pathogenesis of pituitary tumors. Nat Rev Cancer. 2002;2:836–849.
  • 3. Nammour GM, Ybarra J, Naheedy MH, Romeo JH, Aron DC. Incidental pituitary macroadenoma: a population-based study. Am J Med Sci. 1997;314:287–291.
  • 4. Chambers EF, Turski PA, LaMasters D, Newton TH. Regions of low density in the contrast-enhanced pituitary gland: normal and pathologic processes. Radiology. 1982;144:109–113.
  • 5. Laird NM, Mosteller F. Some statistical methods for combining experimental results. Int J Technol Assess Health Care. 1990;6:5–30.
  • 6. Yue NC, Longstreth WT Jr., Elster AD, Jungreis CA, O’Leary DH, Poirier VC. Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the cardiovascular health study. Radiology. 1997;202:41–46.
  • 7. Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH. Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Intern Med. 1994;120:817–820.
  • 8. Chong BW, Kucharczyk W, Singer W, George S. Pituitary gland MR: a comparative study of healthy volunteers and patients with microadenomas. Am J Neuroradiol. 1994;15: 675–679.
  • 9. Muhr C, Bergstrom K, Grimelius L, Larsson SG. A parallel study of the roentgen anatomy of the sella turcica and the histopathology of the pituitary gland in 205 autopsy specimens. Neuroradiology. 1981;21:55– 65.
  • 10. Teramoto A, Hirakawa K, Sanno N, Osamura Y. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology. 1994;193:161–164.
  • 11. Burrow GN, Wortzman G, Rewcastle NB, Holgate RC, Kovacs K. Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med. 1981;304:156–158.
  • 12. Costello RT. Subclinical adenoma of the pituitary gland. Am J Pathol. 1936;12:205–214.
  • 13. Parent AD, Bebin J, Smith RR. Incidental pituitary adenomas. J Neurosurg. 1981;54:228–231.
  • 14. Siqueira MG, Guembarovski AL. Subclinical pituitary microadenomas. Surg Neurol. 1984;22:134–140.
  • 15. Tomita T, Gates E. Pituitary adenomas and granular cellt umors: incidence, cell type, and location of tumor in 100 pituitary glands at autopsy. Am J Clin Pathol. 1999;111:817–825.
  • 16. McComb DJ, Ryan N, Horvath E, Kovacs K. Subclinical adenomas of the human pituitary. New light on old problems. Arch Pathol Lab Med. 1983;107:488–491.
  • 17. Watson JC, Shawker TH, Nieman LK, DeVroom HL, Doppman JL, Oldfield EH. Localization of pituitary adenomas by using intraoperative ultrasound in patients with Cushing’s disease and no demonstrable pituitary tumor on magnetic resonance imaging. J Neurosurg. 1998;89:927–932.
  • 18. Regal M, Paramo C, Sierra SM, Garcia-Mayor RV. Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clin Endocrinol (Oxf). 2001;55:735–740.
  • 19. Elster AD. Modern imaging of the pituitary. Radiology. 1993; 187:1–14.
  • 20. Surawicz TS, McCarthy BJ, Kupelian V, Jukich PJ, Bruner JM, Davis FG. Descriptive epidemiology of primary brain and CNS tumors: results from the central brain tumor registry of the United States, 1990-1994. Neuro-oncol. 1999;1:14 –25.
  • 21. CBTRUS (2002–2003). Statistical Report: Primary Brain Tumors in the United States, 1995–1999. Hinsdale, IL: Central Brain Tumor Registry of the United States, 2002.
  • 22. Nilsson B, Gustavasson-Kadaka E, Bengtsson BA, Jonsson B. Pituitary adenomas in Sweden between 1958 and 1991: incidence, survival, and mortality. J Clin Endocrinol Metab. 2000;85:1420–1425.

Can Pituitary Tumors Be Inherited?
By Robert F. Gagel, M.D.


  • 1. Brandi ML, Gagel RF, Angeli A, Bilezikian JP, Beck-Peccoz P, Bordi C, Conte-Devolx B, Falchetti A, Gheri RG, Libroia A, Lips CJ, Lombardi G, Mannelli M, Pacini F, Ponder BA, Raue F, Skogseid B, Tam- burrano G, Thakker RV, Thompson NW, Tomassetti P, Tonelli F, Wells SA Jr, Marx SJ: Guidelines for diagnosis and management of MEN type 1 and type 2. J Clin Endocrinol Metab 2001; 86: 5658-71.
  • 2. Melmed S, Kleinberg D: Anterior Pituitary, in: Larsen R, Kronenberg H, Melmed S, Polonsky K (eds): Williams Textbook of Endocrinology (10th edition). Philadelphia, W.B. Saunders Company, 2008,
    3. 155-261.
  • 4. Gagel RF, Marx S: Multiple Endocrine Neoplasia, in: Larsen R, Kronenberg H, Melmed S, Polon- sky K (eds): Williams Textbook of Endocrinology (11th edition). Philadelphia, W.B. Saunders Company,
    5. 2008, 1705-1746.
  • 6. Kirschner LS, Carney JA, Pack SD, Taymans SE, Giatzakis C, Cho YS, Cho-Chung YS, Stratakis, CA: Mutations of the gene encoding the protein kinase A type I-alpha regulatory subunit in patients with the Carney complex, Nature Genetics 26; 89-92, 2000.
  • 7. Beckers A, Aaltonen LA, Daly AF, Karhu A: Familial isolates pituitary adenomas (FIPA) and the pituitary adenoma predisposition due to mutations in the aryl hydrocarbon receptor interacting protein (AIP) gene. Endocr Rev 34:239-77, 2013.


ACTH – adrenocorticotropic hormone
AIP – aryl-hydrocarbon interacting protein
CNC – Carney Complex
DNA – deoxyribonucleic acid
GH – growth hormone
MEN1 – multiple endocrine neoplasia, type 1
PRKAR1A – regulatory subunit of protein
PRL – Prolactin
TSH – thyroid stimulating hormone

Chapter Two: The Diagnosis of Pituitary Diseases

By Shereen Ezzat, M.D., F.R.C.P.(C). F.A.C.P.

Suggested Readings:

  • 1. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly. Endocr Pract. 2004;10:213-25.
  • 2. American Association of Clinical Endocrinologists Medicine Guidelines for the diagnosis and treatment of acromegaly. Endocr Pract. 2011 Jul-Aug;17 Suppl 4:1-44.
  • 3. Pita-Gutierrez F, Pertega-Diaz S, Pita-Fernandez S, Pena L, Lugo G, Sangiao-Alvarellos S, Cordido F. Place of preoperative treatment of acromegaly with somatostatin analog on surgical outcome: a systematic review and meta-analysis. PLoS One. 2013 Apr 25;8(4):e61523.
  • 4. Trainer, P.J., Drake, W.M., Katznelson, L., et al. Treatment of acromegaly with the growth hormone-receptor antagonist Pegvisomant. N. Engl. J. Med. 2000;342:1171-7
  • 5. Ezzat, S., Living with acromegaly. Endocrinol. Metab. Clin. North Am. 1992;21:753.

By Michael O. Thorner, M.B., D.Sc., Edited by Shereen Ezzat, M.D.

Cushing’s Syndrome/Disease
By Shirley McCartney, Ph.D., Christine Yedinak, D.N.P., and Maria Fleseriu, M.D., F.A.C.E.

Cushing’s Syndrome: An Update
By Laurence Katznelson. M.D.

Gonadotroph And Other Clinically Nonfunctioning Pituitary Adenomas
By Peter J. Snyder, M.D.

Multiple Endocrine Neoplasia Type 1 (MEN1)
By Stephen J. Marx, M.D.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other Institutes of the National Institutes of Health conduct and support research in endocrine disorders, including MEN1. Researchers are conducting genetic studies to better understand MEN1 gene mutations and their effects. Other studies are examining new drug treatments for hyperparathyroidism, carcinoid tumors, and pancreatic islet tumors. The psychosocial aspects of MEN1 are also under investigation.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.


  • 1. White ML, Doherty GM. Multiple endocrine neoplasia. Surgical Oncology Clinics of North America. 2008;17:439-459.
  • 2. Jensen RT. Management of the Zollinger-Ellison syndrome in patients with multiple endocrine neoplasia type 1. Journal of Internal Medicine. 1998;243(6):477-488.
  • 3. Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, eds. Williams Textbook of Endocrinology. 10th ed. Philadelphia: Saunders; 2003.
  • 4. Gardner DG, Shoback D, eds. Greenspan's Basic and Clinical Endocrinology. 8th ed. New York: McGraw-Hill; 2007.
  • 5. Ozawa A, Agarwal SK, Mateo CM, et al. The parathyroid/pituitary variant of MEN1 usually has causes other than p27Kip1 mutations. The Journal of Clinical Endocrinology and Metabolism. 2007;92:1948-1951.

For More Information

Pituitary Network Association
P.O. Box 1958
Thousand Oaks, CA 91358
Phone: 805-499-9973
Fax: 805-480-0633
Email: pna@pituitary.org
Internet: www.pituitary.org

March of Dimes
1275 Mamaroneck Avenue
White Plains, NY 10605
Phone: 1–888–MODIMES (1–888–663–4637) or 914-428-7100
Fax: 914–428–8203
Email: askus@marchofdimes.com
Internet: www.marchofdimes.com

The Genetic Alliance
4301 Connecticut Avenue, NW, Suite 404
Washington, D.C. 20008-2369
Telephone: 1–800–336–GENE (1–800–336–4363) or 202-966-5557
Fax: 202-966-8553
E-mail: info@geneticalliance.org
Home Page: www.geneticalliance.org

American Academy of Otolaryngology-Head and Neck Surgery
1650 Diagonal Road
Alexandria, VA 22314-2857
Phone: 703-836-4444
Internet: www.entnet.org


Publications produced by the NIDDK are carefully reviewed by both NIDDK scientists and outside experts. This publication was originally written and updated by Stephen J. Marx, M.D., NIDDK.

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit their website atwww.fda.gov. Consult your doctor for more information.

National Endocrine and Metabolic Diseases Information Service

6 Information Way
Bethesda, MD 20892–3569
Phone: 1–888–828–0904
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: endoandmeta@info.niddk.nih.gov
Internet: www.endocrine.niddk.nih.gov

The National Endocrine and Metabolic Diseases Information Service is an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health, which is part of the U.S. Department of Health and Human Services.

The NIDDK conducts and supports biomedical research. As a public service, the NIDDK has established information services to increase knowledge and understanding about health and disease among patients, health professionals and the public.

This publication is not copyrighted. The NIDDK encourages users of this publication to duplicate and distribute as many copies as desired.

NIH Publication No. 10-3048
November 2009
Page last updated April 6, 2012

Autoimmune Pituitary Disease or Lymphocytic Hypophysitis
By Patricia Crock, M.D., M.B.B.S., F.R.A.C.P.

Addison’s Disease
By Eileen K. Corrigan, N.I.H., Retired

Suggested Readings:

The following materials can be found in medical libraries, many college and university libraries, and through interlibrary loan in most public libraries.

  • 1. Wingert, Terence D. and Mulrow, Patrick J., “Chronic Adrenal Insufficiency,” in Current Diagnosis, edited by Rex B. Conn. Philadelphia, MI.B. Saunders Company, 1985, pp 860-863.
  • 2. Bravo, Emmanuel L., “Adrenocortical Insufficiency,” in Conn’s Current Therapy, edited by Robert E. Rakel. Philadelphia, W.B. Saunders Company, 1987, pp 493-495.
  • 3. Bondy, Philip K., “Disorders of the Adrenal Cortex,” in Williams Textbook of Endocrinology, seventh edition, edited by Jean D. Wilson and Daniel W. Foster. Philadelphia, R.B. Saunders Company, 1985, pp 844-858.
  • 4. Loriaux, D. Lynn and Cutler, Gordon B., “Diseases of the Adrenal Glands,” in Clinical Endocrinology, edited by Peter O. Kohler. New York, John Wiley & Sons, 1986, pp 208-215.
  • 5. Williams, Gordon H. and Dluhy, Robert G., “Diseases of the Adrenal Cortex,” in Harnson’s Principles of Internal Medicine, 11th edition, edited by Eugene Braunwald, Kurt J. Isselbacher, Robert G. Petersdorf, Jean D. Wilson, Joseph B. Martin, and Anthony S. Fauci. New York, McGraw-Hill Book Company, 1987, pp 1769-1772.
  • 6. Baxter, John D. and Tyrrell, Blake, “The Adrenal Cortex,” in Endocrinolegy and Metabolism, second edition, edited by Philip Felig,, John D. Baxter, Arthur E. Broadus, and Lawrence A. Frohman. New York, McGraw-Hill Book Company, 1987, pp 581-599.

Pituitary Cancer
By Hasnaian M. Khandwala, M.D., Ian E. McCutcheon, M.D., F.R.C.S. and Keith E. Friend, M.D.


  • 1. Cartwright DM, Miller TR and Nasr AJ. Fine needle aspiration biopsy of pituitary carcinoma with cervical lymph node metastasis: report of a case and review of the literature. Diag Cytopath 11:68-73, 1994.
  • 2. King AB. The diagnosis of carcinoma of the pituitary gland. Bull Johns Hopkins Hosp 89:339-353, 1951.
  • 3. Kovacs K and Horvarth E. Tumors of the pituitary gland. Washington DC, Armed forces Institute of Pathology, 1986, pp 217-224.
  • 4. Lubke D and Saeger W. Carcinomas of the pituitary. Definition and review of the literature. Gen Diag Pathol 141:81-92, 1995.
  • 5. McCutcheon IE, Pieper DR, Fuller GN, Benjamin RS, Friend KE, Gagel RF. Pituitary carcinoma containing gonadotropins: treatment by radical excision and cytotoxic chemotherapy. Neurosurgery 46:1233-1239, 2000.

Chapter Three: Complications of Pituitary Disease

Heart Problems in Acromegaly
By Philippe Chanson, M.D.


  • 1. Orme SM, McNally RJ, Cartwright RA, Belchetz PE. Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab 1998;83 (8):2730-4.
  • 2. Lopez-Velasco R, Escobar-Morreale HF, Vega B, Villa E, Sancho JM, Moya-Mur JL, et al. Cardiac involvement in acromegaly: specific myocardiopathy or consequence of systemic hypertension? J Clin Endocrinol Metab 1997;82(4):1047-53.
  • 3. Maison P, Demolis P, Young J, Schaison G, Giudicelli JF, Chanson P. Vascular reactivity in aromegalic patients: Preliminary evidence for regional endothelial dysfunction and increased sympathetic vasoconstriction. Clin Endocrinol (OxF) 2000;53 (4): 445-51.
  • 4. Sacca L, Cittadini A, Fazio S. Growth hormone and the heart. Endocr Rev 1994;15(5):555-73.
  • 5. Frustaci A, Chimenti C, Setoguchi M, Guerra S, Corsello S, Crea F, et al. Cell death in acromegalic cardiomyopathy. Circulation 1999;99(11):1426-34.
  • 6. Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000;85(2):526-9.
  • 7. Pinzone JJ, Katznelson L, Klibanski A. Acromegalic heart disease. The Endocrinologist 1998;8:273-8.
  • 8. Colao A, Cuocolo A, Marzullo P, Nicolai E, Ferone D, Della Morte AM, et al. Impact of patient’s age and disease duration on cardiac performance in acromegaly: a radionuclide angiography study. J Clin Endocrinol Metab 1999;84(5):1518-23.
  • 9. Chanson P, Timsit J, Masquet C, Warnet A, Guillausseau PJ, Birman P, et al. Cardiovascular effects of the somatostatin analog octreotide in acromegaly. Ann Intern Med 1990;113(12): 921-5.
  • 10. Lim MJ, Barkan AL, Buda AJ. Rapid reduction of left ventricular hypertrophy in acromegaly after suppression of growth hormone hypersecretion. Ann Intern Med 1992;117(9):719-26.
  • 11. Giustina A, Boni E, Romanelli G, Grassi V, Giustina G. Cardiopulmonary performance during exercise in acromegaly, and the effects of acute suppression of growth hormone hypertreatments, personalized attention and compassionate care.

Pituitary Disease: Association With Cognitive Dysfunction
By Wesley P. Fairfield, M.D.


  • 1. Cushing H. Psychic disturbances associated with disorders of the ductless glands. Am J Insanity 1913; 69:965-990.
  • 2. Crane TB, Yee RD, Hepler RS, Hallinan JM. Clinical manifestations and radiologic findings in craniopharyngiomas in adults. Am J Ophthalmol 1982; 94: 220-8.
  • 3. Cushing H. Basophilic adenomas of the pituitary body and their clinical manifestations. Bull Johns Hopkins Hosp 1932; 50:137.
  • 4. Dorn LD, Burgess ES, Dubbert B, et al. Psychopathology in patients with endogenous Cushing’s syndrome: ‘atypical’ or melancholic features. Clin Endocrinol (Oxf) 1995; 43:433-42.
  • 5. Kelly WF. Psychiatric aspects of Cushing’s syndrome. Qjm 1996; 89:543-51.
  • 6. Dorn LD, Burgess ES, Friedman TC, Dubbert B, Gold PW, Chrousos GP. The longitudinal course of psychopathology in Cushing’s syndrome after correction of hypercortisolism. J Clin Endocrinol Metab 1997; 82:912-9.
  • 7. Baum HB, Katznelson L, Sherman JC, et al. Effects of physiological growth hormone (GH) therapy on cognition and quality of life in patients with adultonset GH deficiency. J Clin Endocrinol Metab 1998; 83:3184-9.
  • 8. Grattan-Smith PJ, Morris JG, Langlands AO. Delayed radiation necrosis of the central nervous system in patients irradiated for pituitary tumours. J Neurol Neurosurg Psychiatry 1992; 55:949-55.
  • 9. Peace KA, Orme SM, Padayatty SJ, Godfrey HP, Belchetz PE. Cognitive dysfunction in patients with pituitary tumour who have been treated with transfrontal or transsphenoidal surgery or medication. Clin Endocrinol (Oxf) 1998; 49:391-6.
  • 10. Guinan EM, Lowy C, Stanhope N, Lewis PD, Kopelman MD. Cognitive effects of pituitary tumours and their treatments: two case studies and an investigation of 90 patients. J Neurol Neurosurg Psychiatry 1998; 65:870-6.

Headaches and Pituitary Tumors
By Peter N. Riskind, M.D., Ph.D.

The Oral Cavity and Pituitary Tumors
By Eric C. Sung, D.D.S.


  • 1. Sugata T, Myoken Y, Tanaka S. Acromegaly identified in a patient with a complaint of malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1): 44-6.
  • 2. Cohen RB, Wilcox CW. A case of acromegaly identified after patient complaint of apertognathia. Oral Surg Oral Med Oral Pathol. 1993 May;75(5): 583-6.
  • 3. Hampton RE. Acromegaly and resulting myofacial pain and temporomandibular joint dysfunction: review of the literature and report of case. J Am Dent Assoc. 1987;114(5): 625-31.
  • 4. Shaw L, Foster TD. Size and development of the dentition in endocrine deficiency. J Pedod. 1989;13(2): 155-60.
  • 5. Modica F, Gallessio C. Alveolar bone necrosis as a consequence of surgical intervention for hypophyseal adenoma. Minerva Stomatol. 1993;42(3): 113-9.
  • 6. Watson SW, Sinn DP, Neuwelt EA. Dental considerations in the sublabial transsphenoidal surgical approach to the pituitary gland. Neurosurgery. 1982;10(2): 236-41.
  • 7. Fox PC. Acquired salivary dysfunction. Drugs and radiation. Ann N Y Acad Sci. 1998;15;842: 132-7.
  • 8. Dreizen S, Daly T, Drane JB. Prevention of xerotomia related dental caries in irradiated cancer patient. J. Dent. Res. 1977;56: 99-104
  • 9. Fox PC. Management of dry mouth. Dent Clin North Am. 1997;41(4):863-75.
  • 10. Fox PC, Vander Van PF, Baum BJ, et al. Pilocarpine for the treatment of xerostomia associated with salivary gland dysfunction. Oral Surg. Oral Med. Oral Pathol. 1986;61:243-8
  • 11. Loesche WJ, Syed SA, Murray RJ, Melberg JR. Effect of topical acidulated phosphate fluoride on percentage of Streptococcus mutans and Streptococcus sanguis in plaque. II. Pooled occulusal and pooled approximal samples. Caries Res. 1975;9(2): 139-55.

Keep an Eye on Yourself
By Nicholas Volpe, M.D.

Surgical Correction of the Acromegalic Face
By J. Timothy Katzen, M.D., Mohammed S. Kabil, and Hrayr K. Shahinian, M.D.


  • 1. Molitch ME. Clinical manifestations of acromegaly. Endocrinology and Metabolism of North America 1992;21:597–614.
  • 2. Lamberts S W J. Acromegaly and its treatment. Journal of Endocrinology 1997; 155:49–51.
  • 3. Chung KC, Buchman SR, Aly HM, Trotman CA. Use of modern craniofacial techniques for comprehensive reconstruction of the acromegalic face. Ann Plast Surg 1996;36:403-8; discussion 403-8.
  • 4. Takakura M, Kuroda T. Morphologic analysis of dentofacial structure in patients with acromegaly. Int J Adult Orthodon Orthognath Surg 1998;13:277-88.
  • 5. Ezzat S, Forster MJ, Berchtold P, Redelmeier DA, Boerlin V, Harris AG. Acromegaly. Clinical and biochemical features in 500 patients. Medicine (Baltimore) 1994;73:233-40.
  • 6. Grunstein RR, Ho KKY, Sullivan CE. Effect of octreotide, a somatostatin analog, on sleep apnea in patients with acromegaly. Ann Intern Med 1994;121:478-83.
  • 7. Dons RF, Rosselet B, Pastakia B, Doppman J, Gorden P. Arthropathy in acromegalic patients before and after treatment: a long-term follow-up study. Clin Endocrinol (Oxf) 1988;28:515-24.
  • 8. Lieberman SA, Hoffman AR. Sequelae to acromegaly: Reversibility with treatment of the primary disease. Horm Metab Res 1990;22:313-8.
  • 9. Bates AS, Van't Hoff W, Jones JM, Clayton RN. An audit of outcome of treatment in acromegaly. Q J Med 1993;86:293-9.
  • 10. Kahaly G, Stover C, Beyer J, Mohr-Kahaly S. Relation of endocrine and cardiac findings in ac- romegalics. J Endocrinol Invest 1992;15:13-8.
  • 11. Ezzat S, Melmed S. Are patients with acromegaly at increased risk for neoplasia? J Clin Endocrinol Metab 1991;72:245-9.

Human Sexuality
By Robert Knutzen, M.B.A.

We are pleased to add these links for your educational curriculum and hope that this will assist you in finding better health and a good life.

CNN.com – Study: One in 100 Adults Asexual: http://www.cnn.com/2004/TECH/science/10/14/asexual.study/

Psychology Today – The New Sex Scorecard: http://www.psychologytoday.com/articles/200306/the-new-sex-scorecard

Planned Parenthood – The Health Benefits of Sexual Expression: http://www.plannedparenthood.org/files/PPFA/BenSex_07-07.pdf

Hormones and Sexuality
By Sandy Hotchkiss, M.S.W., BCD

The author wishes to thank Theresa L. Crenshaw, M.D., whose 1996 book, “The Alchemy of Love and Lust” synthesized the current research on hormones and sexuality and provided most of the information for this article.

The Mental Health Side of Pituitary and other Neuroendocrine Disorders
Linda M. Rio, MA, Marriage and Family Therapist

Sick of Being Sick and Tired: When Depression is Not Depression
By Michael A. Weitzner, M.D.


  • 1. Weitzner MA (1998) Neuropsychiatry and pituitary disease: An overview. Psychotherapy and Psychosomatics, 67, 125-132.
  • 2. Hann DM, Jacobsen PB, Martin SC, Kronish LE, Azzarello LM, Fields KK (1997) Fatigue in women treated with bone marrow transplantation for breast cancer: a comparison with women with no history of cancer. Supportive Care Cancer 5, 44-52.
  • 3. Aaronson LS, Teel CS, Cassmeyer V, Neuberger GB, Pallikkathayil L, Pierce J, Press AN, Williams PD, Wingate A (1999) Defining and Measuring fatigue. Image – the Journal of Nursing Scholarship, 31 (1), 45-50.
  • 4. Kennedy HG (1988) Fatigue and fatigability. British Journal of Psychiatry, 153, 1-5.
  • 5. Cimprich B (1992) Attentional fatigue following breast cancer surgery. Research in Nursing & Health, 15 (3), 199-207.
  • 6. Cimprich B (1993) Development of an intervention to restore attention in cancer patients. Cancer Nursing, 16 (2), 83-92.
  • 7. Marin RS (1997) Apathy—Who cares? An introduction to apathy and related disorders of diminished motivation. Psychiatric Annals, 27, 18-23.
  • 8. Duffy JD (1997) The neural substrates of motivation. Psychiatric Annals, 27, 24-29.
  • 9. Mogenson GJ, Brudzynski SM, Wu M, Yang CR, Yim CY (1993) From motivation to action: A review of limbic, nucleus accumbens, ventral pallidum, pedunculopontine nucleus circuitries involved in limbic-motor integration. In, Kalivas PW, Barnes CD, eds. Limbic Motor Circuits and Neuropsychiatry, Boca Raton, FL, CRC Press.
  • 10. Kalivas PW, Churchill L, Kliteneck MA (1993) The circuitry mediating the translation of motivational stimuli into adaptive motor responses. In, Kalivas PW, Barnes CD, eds. Limbic Motor Circuits and Neuropsychiatry, Boca Raton, FL, CRC Press.
  • 11. Cimprich B (1995) Symptom management: loss of concentration. Seminars in Oncology Nursing, 11(4), 279-88.
  • 12. Varley CK, Trupin EW (1983) Double-blind assessment of stimulant medication for attention deficit disorder: A model for clinical application. American Journal of Orthopsychiatry, 53, 542-547.
  • 13. Wilens TE, Biederman J (1992) The stimulants.

The Stress Response and Its Implications for Pituitary Tumors
By George Chrousos, M.D. and Robert Bock

Emotional Disorder Medications

Chapter Four: Common Issues for Women

The Menstrual Cycle – Getting the “Vital” Respect it Deserves
A Compilation of Abstracts Presented

Psychosocial Aspects of Pituitary Disease in Women
By Donna E. Stewart, M.D., F.R.C.P.C.

Pituitary Disease During Pregnancy
By Martin N. Montoro, M.D. and Jorge H. Mestman, M.D.

Chapter Five: Common Issues for Children

Panhypopituitarism in Childhood
By Mitchell E. Geffner, M.D.

Suggested Readings:

  • 1. Ahmad T, Garcia-Filion P, Borchert M, Kaufman F, Burkett L, Geffner M. Endocrinological and auxological abnormalities in young children with optic nerve hypoplasia: a prospective study. J Pediatr. 2006;148:78-84.
  • 2. May JA, Krieger MD, Bowen I, Geffner ME. Craniopharyngioma in childhood. Adv Pediatr. 2006;53:183-209.
  • 3. Ouyang T, Rothfus WE, Ng JM, Challinor SM. Imaging of the pituitary. Radiol Clin North Am. 2011;49:549-71.
  • 4. Pade K, GEFFNER ME. Specific to Children. Pituitary Disorders: Diagnosis and Management. In: Laws ER, Ezzat S, Asa SL, Rio LM, Michel L (eds). 1st edition. Wiley-Blackwell, UK, 2012 (in press).

Pediatric Pituitary Tumors
By Cheryl A. Muszynski, M.D.


  • 1. Abe T, Tara LA, Ludecke DK. Growth hormone secreting pituitary adenomas in childhood and adolescence: features and results of transnasal surgery. Neurosurgery 45(1):1-10, 1999.
  • 2. Agarwal A, Mahapatra AK, Sharma MC. Pituitary tumours. Indian J Pediatr 65(1):107-14, 1998.
  • 3. Asa, SL. Tumors of the pituitary gland. Atlas of tumor pathology. 3rd series, Fascicle 22. Washington: Armed Forces Institute of Pathology, 1998.
  • 4. Chandler WF, Schteingart DE, Lloyd RV, McKeever PE, Ibarra-Perez G. Surgical treatment of Cushing’s disease. J Neurosurg. 66:204-212, 1987.
  • 5. Costin G. Endocrine disorders associated with tumors of the pituitary and hypothalamus. Pediatr Clin North Am. 26:15-31, 1979.
  • 6. Dastur DK, Lalitha US. Pathological analysis of intracranial space-occupying lesions in 1000 cases including children. Pituitary adenomas, developmental tumors, parasitic and developmental cysts. J Neurol Sciences. 15:397-427, 1972.
  • 7. David M, Bernard-Weil E, Pradat P. Adenomes hypophisaires de l’enfant. Revue Neurol. 106:334-336, 1962.
  • 8. Dyer EH, Civit T, Visot A, Delalande O, Derome P. Transsphenoidal surgery for pituitary adenomas in children. Neurosurgery. 34:207-212, 1994.
  • 9. Fideleff HL, Boquete HR, Sequera A, Suarez M, Sobrado P, Giaccio A. Peripubertal prolactinomas: clinical presentation and long-term outcome with different therapeutic approaches. J Pediatr Endocrinol Metab. 13(3):261-7, 2000.
  • 10. Fraioli B, Gerrante L, Celli P. Pituitary adenomas with onset during puberty. J Neurosurgery. 59:590-595, 1983.
  • 11. Freda, PU, Wardlaw, SL. Diagnosis and treatment of pituitary tumors. J Clin Endocrinol Metab. 84:3859-3866, 1999.
  • 12. Friedman RB, Oldfield EH, Nieman LK, Chrousos GP, Doppman JL, Cutler GB, Loriaux DL. Repeat transsphenoidal surgery for Cushing’s disease. J Neurosurgery. 71:520-527, 1989.
  • 13. Gaini SM, Giovannelli M, Forni C, Villani R, Scuccimarra A, Carteri A, Iraci G. Pituitary adenomas in infancy and childhood. In: Villani R, Giovannelli M, Gaini SM, eds. Modern Problems in Paediatrics. Basel: Karger. 220-225, 1977.
  • 14. Haddad SF, Van Gilder JC, Menezes AH. Pediatric pituitary tumors. Neurosurgery. 29:509-514, 1991.
  • 15. Hardy, J. Transsphenoidal microsurgical removal of pituitary microadenoma. In: Krayenbuhl H, Maspes PE, Sweet WH, eds. Progress in Neurological Surgery. Basel: Karger. 200-216, 1975.
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  • 17. Hubbard JL, Scheithauer BW, Abboud CF, Laws ER. Prolactin-secreting adenomas: the preoperative response to bromocriptine treatment and surgical outcome. J Neurosurgery. 67:816-821, 1987.
  • 18. Im SH, Wang KC, Kim SK, Chung YN, Kim HS, Lee CH, Cho BK. Transsphenoidal microsurgery for pediatric craniopharyngioma: special considerations regarding indications and method. Pediatr Neurosurg. 39(2):97-103, 2003.
  • 19. Johnson J, Chrousos GP, Nieman LK, Doppman JL, Cutler GB, Oldfield EH. Transsphenoidal microsurgery for Cushing’s disease in children (abstr). Presented at the 61st Annual Meeting of the American Association of Neurological Surgeons, Boston, April 24-29, 1993.
  • 20. Kane LA, Leinung MC, Scheithauer BW, Bergstralh EJ, Laws ER Jr., Groover RV, Kovacs K, Horvath E, Zimmerman D. Pituitary adenomas in childhood and adolescence. J Clin Endocrinol Metab. 79:1135-1140, 1994.
  • 21. Kaye, AH, Laws ER, eds. Brain tumors. An encyclopedic approach. Edinburgh: Churchill Livingstone, 1995.
  • 22. Koos WT, Miller MH. Intracranial tumors of infants and children. Stuttgart: G. Thieme Verlag. 213-220, 1971.
  • 23. Kovacs K, Horvath E. Tumors of the Pituitary Gland. In: Hartmann WH, Sobin LH, eds. Atlas of Tumor Pathology. Washington, D.C.: Armed Forces Institute of Pathology. 206, 1986.
  • 24. Kunwar S, Wilson CB. Pediatric pituitary adenomas. J Clin Endocrinol Metab. 84:4385–4389, 1999.
  • 25. Laws ER Jr., Fode NC, Randall RV, Abboud CF, Coulam CB. Pregnancy following transsphenoidal resection of prolactin-secreting pituitary tumors. J Neurosurg. 58:685-688, 1983.
  • 26. Laws ER Jr., Scheithauer BW, Groover RV. Pituitary adenomas in childhood and adolescence. Prog Exp Tumor Res. 30:359-361, 1987.
  • 27. Laws ER Jr. Pituitary Tumors – Therapeutic Considerations: Surgical. In: Barrow DL, Selman WR, eds. Neuroendocrinology, Concepts in Neurosurgery. Baltimore: Williams & Wilkins. 5:395-400, 1992.
  • 28. Lucas C, Guibout M, Jaquet P, Grisoli F, Giraud F. Aspects diagnostiques et evolutifs de l’adenome a prolactine chez l’enfant. Arch Fr Pediatr. 37:79-86, 1980.
  • 29. Ludecke DK, Herrman HD, Schulte FJ. Special problems with neurosurgical treatment of hormone secreting pituitary adenomas in children. Prog Exp Tumor Res. 30:362-370, 1987.
  • 30. Maira G, Anile C. Pituitary adenomas in childhood and adolescence. Can J. Neurol Sciences. 17: 83-87, 1990.
  • 31. Mickle JP. Cushing’s Disease in childhood. In: Marlin AE, ed. Concepts in Pediatric Neurosurgery. Basel: Karger. 9:65-76, 1989.
  • 32. Mindermann T, Wilson CB. Pediatric pituitary adenomas. Neurosurgery. 36:259-269, 1995.
  • 33. Mizutani T, Teramoto A, Aruga T, Takakura K, Sanno N. Prepubescent pituitary null cell macroadenoma with silent macroscopic apoplexy: case report. Neurosurgery. 33(5):907-910, 1993.
  • 34. Moss-Salentijn L. Anatomy and embryology. In: Blitzer A, Lawson W, Friedman WH, eds. Surgery of the Paranasal Sinuses. Philadelphia: W.B. Saunders. 1-22, 1985.
  • 35. Nimsky Ch, Rachinger J, Iro H, Fahlbusch R. Adaptation of a hexapod-based robotic system for extended endoscope-assisted transsphenoidal skull base surgery. Minim Invasive Neurosurg. 47(1):41-6, 2004.
  • 36. Odom GL, Davis CH, Woodhall B. Brain tumors in children: Clinical analysis of 164 cases. Pediatrics. 18:856-870, 1956.
  • 37. Partington MD, Davis DH, Laws ER Jr., Scheithauer BW. Pituitary adenomas in childhood and adolescence. Results of transsphenoidal surgery. J Neurosurgery. 80(2):209-216, 1994.
  • 38. Pinto G, Zerah M, Trivin C, Brauner R. Pituitary apoplexy in an adolescent with prolactin-secreting adenoma. Horm Res 50(1):38-41, 1998.
  • 39. Richmond IL, Wilson CB. Pituitary adenomas in childhood and adolescence. J Neurosurgery. 49:163-168, 1978.
  • 40. Riskind PN. Headaches and pituitary tumors. Massachusetts General Hospital Neuroendocrine Center Bulletin. 1(2):4, 1996.
  • 41. Scamoni C, Balzarini C, Crivelli G, Dorizzi A. Treatment and long-term follow-up results of prolactin-secreting pituitary adenomas. J Neurosurg Sci. 35:9-16, 1991.
  • 42. Schulder M, Sernas TJ, Carmel PW. Cranial surgery and navigation with a compact intraoperative MRI system. Acta Neurochir Suppl. 85:79-86, 2003.
  • 43. Stephanian E, Lunsford LD, Coffey RJ, Bissonette DJ, Flickinger JC. Gamma knife surgery for sellar and suprasellar tumors. Neurosurgery Clinics of North America. 3(1):207-218, 1992.
  • 44. Styne DM, Grumbach MM, Kaplan SL, Wilson CB, Conte FA. Treatment of Cushing’s disease in childhood and adolescence by transsphenoidal microadenomectomy. N Engl J Med. 310:889-893, 1984.
  • 45. Thapar K and Kovacs K. Neoplasms of the sellar region. In: Bigner DD, McLendon R, Bruner J, eds. Russell and Rubinstein’s pathology of tumors of the nervous system. 6th ed. London: Arnold, 1998.
  • 46. Tindall GT, Woodard EJ, Barrow DL. Transsphenoidal excision of macroadenomas of the pituitary gland. In: Rengachary SS, Wilkins RH, eds. Neurosurgical Operative Atlas. Baltimore: Williams & Wilkins. 1: 287-298, 1991.
  • 47. Tomita T, Gates E. Pituitary adenomas and granular cell tumors. Incidence, cell type, and location of tumor in 100 pituitary glands at autopsy. Am J Clin Pathol. 111(6):817-25,1999.
  • 48. Walker DG, Ohaegbulam C, Black PM. Frameless stereotaxy as an alternative to fluoroscopy for transsphenoidal surgery: use of the InstaTrak-3000 and a novel headset. J Clin Neurosci. 9(3):294-297, 2002.
  • 49. Wilson CB, Dempsey LC. Transsphenoidal microsurgical removal of 250 pituitary adenomas. J Neurosurgery. 48:13-22, 1978.
  • 50. Wilson, CB. Surgical management of pituitary tumors. J Clin Endocrinol Metab. 82:2381-2385, 1997.

Chapter Six: Common Issues for Men

Androgen Deficiency and Hypogonadism

Chapter Seven: Testing

Progress in Pathology: What We Have Learned About The Causes of Pituitary Tumors
By Sylvia L. Asa, M.D., Ph.D.

Laboratory Assessment of Pituitary Gland Function
By Jon M. Nakamoto, M.D., Ph.D. and Delbert A. Fisher, M.D.


Chapter One: Medical Options

Indications for Treatment of Microprolactinomas: An Update
By Anne Klibanski, M.D.

Chapter Two: Surgical Options

Management of Pituitary Adenomas
By Edward R. Laws Jr., M.D., F.A.C.S. and John A. Jane Jr., M.D.


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  • 3. Baskin DS, Boggan JE, Wilson CB: Transsphenoidal microsurgical removal of growth hormone-secreting pituitary adenomas. A review of 137 cases. J Neurosurg 56:634-641, 982
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  • 40. Tomita T, Gates E: Pituitary adenomas and granular cell tumors. Incidence, cell type, and location of tumor in 100 pituitary glands at autopsy. Am J Clin Pathol 111:817-825, 1999
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Surgical Management of Pituitary Tumors
By Sandeep Kunwar, M.D. and Charles B. Wilson, M.D., D.Sc., M.S.H.A.

Pituitary Surgery: The Fully Endoscopic Supraorbital Approach
By Hrayr K. Shahinian, M.D. and Yoon Ra, M.S.


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  • 5. Kabil MS, Jarrahy R, Shahinian HK. The application of craniofacial techniques and intracranial endoscopy to pituitary surgery. J Craniofac Surg 2005;16(4).
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  • 7. KingWA,Wackym PA, Sen C, et al. Neurosurgery 2001;49(1):108 - 15[discussion 115-6].
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  • 10. Paladino J, Piker N, Stern PR. Eyebrow keyhole approach in vascular neurosurgery. Minim Invasive Neurosurg 1998;41:200- 3.
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  • 14. Shahinian HK, et.al. Endoscopic Skull Base Surgery. New Jersey: Humana Press; 2008

Skull Base Approaches for Pituitary Tumors – and Intraoperative MRI to Confirm the Amount of Pituitary Tumor Removal
By Robert J. Bohinski, M.D., Ph.D., Michael J. Link, M.D. and John M. Tew Jr., M.D.

Endonasal Endoscopic Pituitary Surgery: Evolution of the Classic Transsphenoidal Approach
By Daniel F. Kelly, M.D., Garni Barkhoudarian, M.D., Chester F. Griffiths, M.D., F.A.C.S., and Kian Karimi, M.D.

Transsphenoidal Resection of Pituitary Adenomas in an Intraoperative MRI Unit
By Claudia H. Martin, M.D., Richard Schwartz, M.D., Ferenc Jolesz, M.D., and Peter Mcl. Black, M.D.


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  • 3. Doppman JL, Zvi R, Shawker TH, et al. Intraoperative US of the pituitary gland: Work in progress. Radiology 1994; 192:111-115.
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Surgical Management of Clinically Nonfunctioning Pituitary Adenomas
By Joshua Rosenow, M.D., and William T. Couldwell, M.D., Ph.D.


  • 1. Arafah BM: Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 62:1173-1179, 1986
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  • 27. Kovacs K, Horvath E: Tumors of the pituitary gland. Fascicle 21. in W (ed): Atlas of Tumor Pathology. Washington, D.C.: Armed Forces Institute of Pathology, 1986, Vol 2nd series
  • 28. Laws ER, Jr.: Comment. Neurosurgery 20:923, 1987
  • 29. Lees PD, Pickard JD: Hyperprolactinemia, intrasellar pituitary tissue pressure, and the pituitary stalk compression syndrome. J Neurosurg 67:192-196, 1987
  • 30. Littley MD, Shalet SM, Beardwell CG, Robinson EL, Sutton ML: Radiation-induced hypopituitarism is dose-dependent. Clin Endocrinol (Oxf) 31:363-373, 1989
  • 31. Littley MD, Shalet SM, Reid H, -term visual changes following pituitary irradiation. Int J Radiat Oncol Biol Phys 33:599-605, 1995
  • 32. Liu JK, Orlandi RR, Apfelbaum RI, Couldwell WT; Novel closure technique for the endonasal transsphenoidal approach. Technical note. J Neurosurg 100:161-164, 2004
  • 33. Liuzzi A, Tassi V, Pirro MT, ea: Nonfunctioning adenoma of the pituitary. Metabolism 45:80-82, 1996
  • 34. McLanaham CS, Christy JH, Tindall GT: Anterior pituitary function before and after transsphenoidal microsurgical resection of pituitary tumors. Neurosurgery 3:142-145, 1978
  • 35. Merola B, Coalo A, Ferone D, Selleri A, Di Sarno A, Marzullo P, et all: Effects of a chronic treatment with octreotide in patients with functionless pituitary adenomas. Horm Res 40:149-155, 1993
  • 36. Movsas B, Movsas TZ, Steinberg SM, Okunieff P: Long-term visual changes following pituitary irradiation. Int J Radiat Oncol Biol Phys 33:599-605, 1995
  • 37. Parent AD, Bebin J, Smith RR: Incidental pituitary adenomas. J Neurosurg 54:228-231, 1981
  • 38. Plowman PN: Pituitary adenoma radiotherapy-when, who and how? Clin Endocrinol (Oxf) 51:265-271, 1999
  • 39. Ridgway EC, Klibanski A, Ladenson PW, Clemmons D, Beitins IZ, McArthur JW, et al: Pure alphasecreting pituitary adenomas. N Engl J Med 304:1254-1259, 1981
  • 40. Rush S, Cooper PR: Symptom resolution, tumor control, and side effects following postoperative radiotherapy for pituitary macroadenomas. Int J Radiat Oncol Biol Phys 37:1031-1034, 1997
  • 41. Schloffer H: Zur frage der operationen an der hypophyse. Beitr Klin Chri 50:767-817, 1906
  • 42. Semple PL, Laws ER, Jr.: Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing's disease. J Neurosurg 91:175-179, 1999
  • 43. Shucart WA, Wu JK: Management of nonfunctioning pituitary tumors, in Tindall GT, Cooper PR, Barrow DL, et al (eds): The Practice of Neurosurgery. Philadelphia: Williams & Wilkins, 1996, pp 1153-1158
  • 44. Snyder PJ: Clinically nonfunctioning pituitary adenomas. Endocrinol Metab Clin North Am 22:163-175, 1993
  • 45. Spencer WR, Das K, Nwagu C, Wenk E, Schaefer SD, Moscatello A, et al: Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope. Laryngoscope 109:791-794, 1999
  • 46. Thapar K, Laws ER, Jr.: Pituitary tumors, in Kaye AH, Laws ER, Jr. (eds): Brain Tumors: An Encyclopedic Approach. New York: Churchill Livingstone, 1995, pp 759-773
  • 47. Turner HE, Stratton IM, Byrne JV, Adams CB, Wass JA: Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation - a follow-up study. Clin Endocrinol (Oxf) 51:281-284, 1999
  • 48. Verde G, Oppizzi G, Chiodini PG, Dallabonzana D, Luccarelli G, Liuzzi A: Effect of chronic bromocriptine administration on tumor size in patients with "nonsecreting" pituitary adenomas. J Endocrinol Invest 8:113-115, 1985
  • 49. Wilson CB: Neurosurgical management of large and invasive pituitary tumors, in Tindall GT, Collins WF (eds): Clinical Management of Pituitary Disorders. New York: Raven Press, 1979, pp 269-276
  • 50. Wilson CB, Dempsey LC: Transsphenoidal microsurgical removal of 250 pituitary adenomas. J Neurosurg 48:13-22, 1978
  • 51. Zervas NT: Surgical results for pituitary adenoma: Results of an international survey, in Black PM, Zervas NT, Ridgway EC (eds): Secretory Tumors of the Pituitary Gland. New York: Raven Press, 1984, pp 377-385

Chapter Three: Radiotherapy Options

Gamma Knife Radiosurgery for Skull Base and Pituitary Tumors
By Ajay Niranjan, MD, MBA, L. Dade Lunsford, M.D., and John C. Flickinger, M.D.


  • 1. Backlund EO, Rahn T, Sarby B, De Schryver A, Wennerstrand J: Closed stereotaxic hypophysectomy by means of 60 Co gamma radiation. Acta Radiol Ther Phys Biol 11:545-555, 1972
  • 2. Bederson JB, von Ammon K, Wichmann WW, Yasargil MG: Conservative treatment of patients with acoustic tumors. Neurosurgery 28:646-650; discussion 650-641, 1991
  • 3. Chang SD, Adler JR, Jr.: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41:1019-1025; discussion 1025-1017, 1997
  • 4. Clark BG, Souhami L, Pla C, Al-Amro AS, Bahary JP, Villemure JG, et al: The integral biologically effective dose to predict brain stem toxicity of hypofractionated stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 40:667-675, 1998
  • 5. Condra KS, Buatti JM, Mendenhall WM, Friedman WA, Marcus RB, Jr., Rhoton AL: Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 39:427-436, 1997
  • 6. Duma CM, Lunsford LD, Kondziolka D, Harsh GRt, Flickinger JC: Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 32:699-704; discussion 704-695, 1993
  • 7. Estrada J, Boronat M, Mielgo M, Magallon R, Millan I, Diez S, et al: The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing's disease. N Engl J Med 336:172-177, 1997
  • 8. Flannery TJ, Kano H, Lunsford LD, Sirin S, Tormenti M, Niranjan A, et al: Long-term control of petroclival meningiomas through radiosurgery. J Neurosurg 112:957-964, 2010
  • 9. Flickinger JC, Deutsch M, Lunsford LD: Repeat megavoltage irradiation of pituitary and suprasellar tumors. Int J Radiat Oncol Biol Phys 17:171-175, 1989
  • 10. Flickinger JC, Lunsford LD, Kondziolka D: Dose prescription and dose-volume effects in radiosurgery. Neurosurg Clin N Am 3:51-59, 1992
  • 11. Flickinger JC, Nelson PB, Martinez AJ, Deutsch M, Taylor F: Radiotherapy of nonfunctional adenomas of the pituitary gland. Results with long-term follow-up. Cancer 63:2409-2414, 1989
  • 12. Foote RL, Coffey RJ, Swanson JW, Harner SG, Beatty CW, Kline RW, et al: Stereotactic radiosurgery using the gamma knife for acoustic neuromas. Int J Radiat Oncol Biol Phys 32:1153-1160, 1995
  • 13. Ganz JC, Backlund EO, Thorsen FA: The effects of Gamma Knife surgery of pituitary adenomas on tumor growth and endocrinopathies. Stereotact Funct Neurosurg 61 Suppl 1:30-37, 1993
  • 14. Gardner JF: How satisfied are your residents? Provider 24:55-56, 1998
  • 15. Goffman TE, Dewan R, Arakaki R, Gorden P, Oldfield EH, Glatstein E: Persistent or recurrent acromegaly. Long-term endocrinologic efficacy and neurologic safety of postsurgical radiation therapy. Cancer 69:271-275, 1992
  • 16. Goldsmith BJ, Wara WM, Wilson CB, Larson DA: Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80:195-201, 1994
  • 17. Hakim R, Alexander E, 3rd, Loeffler JS, Shrieve DC, Wen P, Fallon MP, et al: Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42:446-453; discussion 453-444, 1998
  • 18. House JW, Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146-147, 1985
  • 19. Kano H, Kondziolka D, Khan A, Flickinger JC, Lunsford LD: Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. J Neurosurg 111:863-873, 2009
  • 20. Kano H, Niranjan A, Kondziolka D, Flickinger JC, Dade Lunsford L: Stereotactic radiosurgery for trigeminal schwannoma: tumor control and functional preservation Clinical article. J Neurosurg 110:553-558, 2009
  • 21. Kondziolka D, Flickinger JC, Perez B: Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Gamma Knife Meningioma Study Group. Neurosurgery 43:405-413; discussion 413-404, 1998
  • 22. Kondziolka D, Lunsford LD, Coffey RJ, Flickinger JC: Stereotactic radiosurgery of meningiomas. J Neurosurg 74:552-559, 1991
  • 23. Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC: Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426-1433, 1998
  • 24. Kondziolka D, Mathieu D, Lunsford LD, Martin JJ, Madhok R, Niranjan A, et al: Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 62:53-58; discussion 58-60, 2008
  • 25. Larsson B, Leksell L, Rexed B, Sourander P, Mair W, Andersson B: The high-energy proton beam as a neurosurgical tool. Nature 182:1222-1223, 1958
  • 26. Leksell L: The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:316-319, 1951
  • 27. Levy RP, Fabrikant JI, Frankel KA, Phillips MH, Lyman JT, Lawrence JH, et al: Heavy-charged-particle radiosurgery of the pituitary gland: clinical results of 840 patients. Stereotact Funct Neurosurg 57:22-35, 1991
  • 28. Linskey ME, Lunsford LD, Flickinger JC: Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery. AJNR Am J Neuroradiol 12:1165-1175, 1991
  • 29. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML: Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 70:145-160, 1989
  • 30. Liu X, Kano H, Kondziolka D, Park KJ, Iyer A, Niranjan A, et al: Gamma knife radiosurgery for clinically persistent acromegaly. J Neurooncol 109:71-79, 2012
  • 31. Liu X, Kano H, Kondziolka D, Park KJ, Iyer A, Shin S, et al: Gamma knife stereotactic radiosurgery for drug resistant or intolerant invasive prolactinomas. Pituitary, 2012
  • 32. Lobato-Polo J, Kondziolka D, Zorro O, Kano H, Flickinger JC, Lunsford LD: Gamma knife radiosurgery in younger patients with vestibular schwannomas. Neurosurgery 65:294-300; discussion 300-291, 2009
  • 33. Maire JP, Caudry M, Guerin J, Celerier D, San Galli F, Causse N, et al: Fractionated radiation therapy in the treatment of intracranial meningiomas: local control, functional efficacy, and tolerance in 91 patients. Int J Radiat Oncol Biol Phys 33:315-321, 1995
  • 34. Martin JJ, Kondziolka D, Flickinger JC, Mathieu D, Niranjan A, Lunsford LD: Cranial nerve preservation and outcomes after stereotactic radiosurgery for jugular foramen schwannomas. Neurosurgery 61:76-81; discussion 81, 2007
  • 35. Mendenhall WM, Friedman WA, Buatti JM, Bova FJ: Preliminary results of linear accelerator radiosurgery for acoustic schwannomas. J Neurosurg 85:1013-1019, 1996
  • 36. Noren G, Arndt J, Hindmarsh T: Stereotactic radiosurgery in cases of acoustic neurinoma: further experiences. Neurosurgery 13:12-22, 1983
  • 37. Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka D: Stereotactic radiosurgery for acoustic nerve tumors in patients with useful preoperative hearing: results at 2-year follow-up examination. J Neurosurg 80:1011-1017, 1994
  • 38. Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka DS: Cranial nerve preservation after stereotactic radiosurgery for small acoustic tumors. Arch Neurol 52:73-79, 1995
  • 39. Park KJ, Kano H, Parry PV, Niranjan A, Flickinger JC, Lunsford LD, et al: Long-term outcomes after gamma knife stereotactic radiosurgery for nonfunctional pituitary adenomas. Neurosurgery 69:1188-1199, 2011
  • 40. Pendl G, Schrottner O, Eustacchio S, Feichtinger K, Ganz J: Stereotactic radiosurgery of skull base meningiomas. Minim Invasive Neurosurg 40:87-90, 1997
  • 41. Pollock BE, Kondziolka D, Flickinger JC, Maitz A, Lunsford LD: Preservation of cranial nerve function after radiosurgery for nonacoustic schwannomas. Neurosurgery 33:597-601, 1993
  • 42. Pollock BE, Lunsford LD, Kondziolka D, Flickinger JC, Bissonette DJ, Kelsey SF, et al: Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 36:215-224; discussion 224-219, 1995
  • 43. Rush S, Cooper PR: Symptom resolution, tumor control, and side effects following postoperative radiotherapy for pituitary macroadenomas. Int J Radiat Oncol Biol Phys 37:1031-1034, 1997
  • 44. Rush SC, Newall J: Pituitary adenoma: the efficacy of radiotherapy as the sole treatment. Int J Radiat Oncol Biol Phys 17:165-169, 1989
  • 45. Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22-39, 1957
  • 46. Stephanian E, Lunsford LD, Coffey RJ, Bissonette DJ, Flickinger JC: Gamma knife surgery for sellar and suprasellar tumors. Neurosurg Clin N Am 3:207-218, 1992
  • 47. Tsang RW, Brierley JD, Panzarella T, Gospodarowicz MK, Sutcliffe SB, Simpson WJ: Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys 30:557-565, 1994

Neuroendocrine Complication of Radiation Therapy for Non-Pituitary Tumors
By Anne Klibanski, M.D. and Howard H. Pai, M.D., FRCPC


  • 1. Littley, M D, Shalet, S M, Beardwell, C G, Robinson, E L, Sutton, M L., Radiation-induced hypopituitarism is dose-dependent. Clinical Endocrinology, 1989. 31: p. 464-373.
  • 2. Constine, Louis S, Woolf, Paul D, Cann, Donald, Mick, Gail, McCormick, Kenneth, Raubertas, Richard F, Rubin, Philip. Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med, 1993. 328: p. 87-94.
  • 3. Pai, Howard H, Katznelson, Laurence, Klibanski, Anne, Finkelstein, Dianne M, Adams, Judith A, Fullerton, Barbara C, Thornton, Allan, Leibsch, Norbert J., Munzenrider, John E. Hypothalamic/Pituitary Gland Dysfunction following High Dose Conformal Mixed Proton-Photon Beam Radiotherapy to the Base of Skull Region: Demonstration of a Dose Effect Relationship using Dose Volume Histogram Analysis. in 41th ASTRO (American Society for Therapeutic Radiology and Oncology) conference. 1999. San Antonio, TX.

Chapter Four: Hormone Replacement Therapy

Pituitary Hormone Replacement in Women
By Jennifer Larsen, M.D.

Growth Hormone Deficiency in Adults
By Bengt-Ake Bengtsson, M.D., Ph.D, updated by Dr. Peter Sonksen

Androgen Deficiency in Women With Hypopituitarism
By Karen K. Miller, M.D.


  • 1. Katznelson L, Finkelstein J, Schoenfeld D, Rosenthal D, Anderson E, Klibanski A. 1996 Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism. J Clin Endocrinol Metab. 81:4358-4365.
  • 2. Bagatell C, Heiman J, Rivier J, Bremner W 1994 Effects of endogenous testosterone and estradiol on sexual behavior in normal young men. J Clin Endocrinol Metab. 78:711-716.
  • 3. Judd H. 1976 Hormonal dynamics associated with the menopause. Clin Obstet Gynecol 19:775-788.
  • 4. Kirschner MA, Bardin CW 1972 Androgen production and metabolism in normal and virilized women. Metabolism 21:667-688.
  • 5. Miller K, Biller B, Hier J, E, Klibanski A. Androgens and bone density in women with hypopituitarism. J Clin Endocrinol Metab 2002;87:2770-2776.
  • 6. Wuster C, Slenczka E, Ziegler R. 1991 Erhohte pravalenz von osteoporose und arteriosklerose bei konventionell. Substituierter hypophysenvorderlappeninsuffizienz: bedarf einer zusatzlichen wachs turnshormonsubstitution? Klin Wochenschr. 69:769-773.
  • 7. Rosen T, Willielmsen L, Landin Wilhelmsen K, Lappas G, Bengtsson B. 1997 Increased fracture frequency in adult patients with hypopituitarism and GH deficiency. European J Endocrinology 137:240-245.
  • 8. Markussis V, Beshyah S, Fisher C, Sharp P, Nicolaides A, Johnston D. 1992 Detection of premature atherosclerosis by high-resolution ultrasonography in symptom-free hypopituitary adults. Lancet 340:1188-92.
  • 9. Behre H, Kliesch S, Leifke E, Link T, Nieschlage. 1997 Long-term effect of testosterone therapy on bone mineral density in hypogonadal men. J Clin Endocrinol Metab 82:2386-2390.
  • 10. Skakkebaek J, Bancroft J, Davidson D, Warner P. 1981 Androgen replacement with oral testosterone undecanoate in hypogonadal men: a double-blind controlled study. Clin Endo (Oxf) 14:49-61.
  • 11. Arlt W, Callies F, Allolio B. 2000 DHEA replacement in women with adrenal insufficiency - pharmacokinetics, bioconversion and clinical effects on well-being, sexuality and cognition. Endocr Res 26:505-11
  • 12. Shifren J, Braunstein G, Simon J, et al. 2000 Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. New Engl J Med 343:682-688


Pituitary Tumors – Long Term Outcomes and Expectations
By Edward R. Laws, M.D., F.A.C.S., and John A. Jane Jr., M.D.

Long-Term Mortality After Transsphenoidal Surgery for Cushing’s Disease
By Brooke Swearingen, M.D.


Patient Story
By Sharmyn McGraw

Patient Story
By Esperanza Ramirez


Chapter One: Physician and Hospital Listings


Pediatric Endocrinologists

Reproductive Endocrinologists


Pediatric Neurosurgeons



Radiation Oncologists

Skull Base Surgery

Hospitals/Medical Centers

Pharmaceutical Company/Corporate Listings

Chapter Two: Additional Help and Resources

A Layman’s Quick Checklist For The Acromegalic’s Symptoms, Tests, Remedies

Learn More About Clinical Trials



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