$100

1. Pituitary Gland • Adrenal Gland • Thyrotoxicosis • 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

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. What is Bitemporal Hemianopsia?

4. Bitemporal Hemianopsia

5. MRI Pituitary 2.8 cm Macroadenoma

6. “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