Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.
From the OHSU Brain Institute
Elena Varlamov, M.D.
Dr. Varlamov is a neuroendocrinologist whose research interests include clinical outcomes of pituitary tumors, treatment of acromegaly, Cushing’s disease and growth hormone deficiency.
Advanced imaging is catching more pituitary tumors than ever before. Often these tumors — once thought to be rare — are found when a patient is being tested for something else.
As many as one in four people may have pituitary adenomas without any symptoms. Most of these will be benign but will merit evaluation and monitoring.
Other than these incidental findings, pituitary disorders are often challenging to diagnose, as many of the complaints are nonspecific or could arise from multiple pathologies.
Symptoms that raise suspicion of a pituitary tumor
Pituitary tumors and other pituitary disorders can have several signs, but most often fall into these categories:
- Neurologic symptoms when a pituitary lesion is large (headaches, loss of peripheral vision, diplopia)
- Hormonal deficiencies (fatigue, unintentional weight change, nausea, hair loss, infrequent menstrual periods, excessive thirst and urination)
- Hormonal overproduction (menstrual irregularities, milky breast discharge, fatigue, weight gain, hirsutism, enlargement of hands and feet, excessive sweating, purple striae and bruising)
Initial lab work for confirmation and referral
If you suspect a patient has a pituitary disorder, a basic diagnostic workup is very helpful to include as part of the referral to help triage the patient correctly. Lab tests should include:
- 8 a.m. serum cortisol (ACTH and cosyntropin stimulation test as needed)
- TSH and free T4
- IGF-1 (insulin-like growth factor-1)
- LH/FSH in both sexes, morning testosterone (men)
- Basic metabolic panel
- Overnight dexamethasone test or 24-hour urine free cortisol if clinical suspicion of Cushing’s disease
Owing to the nuances of pituitary disease, interpretation of a laboratory evaluation can be challenging. The OHSU neuroendocrinology consultation service can provide consultation before and after performing laboratory tests and arrange for more complex dynamic endocrine testing for comprehensive evaluation in specific cases.
Multidisciplinary approach to pituitary diseases
The OHSU Pituitary Center treats more than 500 patients a year at a multidisciplinary clinic that teams neuroendocrinologists, neurosurgeons, neuro-ophthalmologists and others.
We are available for urgent referrals and have several clinical trials underway. We work closely with you to make decisions and create care plans for your patients.
When to refer or seek advice
- Pituitary lesion found from MRI/CT (Large pituitary lesions accompanied by neurologic symptoms usually require an urgent consultation).
- Abnormal test results (e.g., elevated prolactin, elevated IGF‑1, low morning serum cortisol).
- Suspicion of Cushing’s syndrome, acromegaly, prolactinoma or hypopituitarism (pituitary hormonal deficiencies).
The OHSU Pituitary Center is your partner in diagnosing and treating all pituitary disorders.
For advice, please call the OHSU Physician Advice and Referral Service at 503‑494‑4567. To refer a patient, please fax to 503‑346‑6854.