What are the indications for referring a patient with a pituitary adenoma to secondary care for surgical evaluation?

Indications for referring a patient with a pituitary adenoma to secondary care for surgical evaluation include:

• Presence of symptoms caused by mass effect such as visual impairment or neurological deficits, which require specialist assessment and potential surgical intervention.

• Evidence of tumour growth or progression on imaging that may threaten neurological function or cause complications.

• Hormonal hypersecretion syndromes caused by functioning pituitary adenomas that are not controlled by medical therapy, necessitating surgical management.

• Failure of or contraindications to medical treatment for hormone-secreting adenomas.

• When the adenoma is causing hypopituitarism or other endocrine dysfunctions requiring specialist endocrine and neurosurgical input.

Referral should be made to a multidisciplinary team with expertise in pituitary disorders and neurosurgery to ensure comprehensive evaluation and management.

Regular monitoring and assessment of pituitary function and tumour status are important, and any new or worsening symptoms should prompt urgent referral.

These indications align with the need for specialist assessment in brain tumours and hypopituitarism as outlined in NICE guidelines, which recommend endocrinology and neurosurgical involvement for pituitary lesions causing clinical or radiological concerns ²,³.