This guideline last updated 07/05/2022 10:14:06

Differential diagnosis

• Non-functioning pituitary tumour
• Macroprolactinoma
• Acromegaly
• Meningioma

Possible management by Optometrist

Treatment

• None

Advice

• Advise GP to check
  • Prolactin (prolactinomas can be treated medically)
  • LH, FSH, oestradiol (women), testosterone (men)
  • 9am cortisol, 9am glc
  • TSH, FT3, FT4
  • IGF-1, if symptoms suggestive of acromegaly
• If vision affected, likely to return to normal with treatment, even if affected for some time

Management Category

• Semi-urgent referral with visual fields to ophthalmology

Possible management by Ophthalmologist

• Endocrine profile
  • Check for hormone over production
  • Check for hypopituitarism
• Neuroimaging
• Referral to endocrinology for macroprolactinomas
• Referral to neurosurgery and endocrinology for all other causes