Pituitary & Adrenal
Adrenal and Pituitary Disorders in San Diego
Prolactin and pituitary tumors, adrenal nodules, primary aldosteronism, cortisol excess and adrenal insufficiency.
The pituitary and adrenal glands are small, but they control blood pressure, metabolism, stress response, fertility and growth. Disorders of these glands are uncommon, often missed for years, and depend on carefully chosen hormone tests. Our endocrinologists evaluate and manage them, and coordinate with neurosurgeons, surgeons and radiologists when imaging or surgery is needed.
Pituitary disorders
The pituitary sits at the base of the brain and directs the thyroid, adrenal glands, ovaries and testes, growth and water balance. Most pituitary tumors (adenomas) are benign. They cause problems either by making too much of a hormone or by pressing on the normal gland or the nerves to the eyes.
Prolactinoma and high prolactin (hyperprolactinemia)
High prolactin can cause irregular or absent periods, milk discharge, infertility, low libido and erectile dysfunction. Medicines, an underactive thyroid and pregnancy are common causes; a prolactin-secreting adenoma is another. Most prolactinomas shrink with medication (cabergoline) and do not need surgery.
Pituitary incidentaloma
Pituitary lesions are often found by chance on brain MRI or CT. Every incidentaloma deserves a hormone evaluation, and larger ones also need a visual field check and follow-up imaging.
Acromegaly and Cushing’s disease
Excess growth hormone causes enlargement of the hands, feet and facial features, joint pain, sleep apnea and diabetes. Excess ACTH from the pituitary causes Cushing’s disease. Both are usually treated with pituitary surgery by an experienced neurosurgeon, with endocrine care before and after.
Hypopituitarism
Damage to the pituitary from a tumor, surgery, radiation or head injury can reduce one or several hormones. Replacing cortisol, thyroid hormone, sex hormones and, when appropriate, growth hormone restores health, but the order and dosing matter.
Adrenal disorders
Adrenal incidentaloma
Adrenal nodules are found on about 1 in 20 abdominal CT scans. Most are benign and hormonally silent, but each should be evaluated once for excess cortisol, aldosterone (in people with high blood pressure or low potassium) and adrenaline-type hormones (pheochromocytoma), and characterized on imaging.
Primary aldosteronism
Primary aldosteronism is one of the most common treatable causes of high blood pressure, yet it is rarely tested for. Consider testing if blood pressure is hard to control, if potassium is low, or if high blood pressure began at a young age. Screening starts with a simple aldosterone and renin blood test. Treatment is either a targeted medicine or, when one adrenal gland is the source, surgery.
Cushing’s syndrome and mild cortisol excess
Too much cortisol causes weight gain around the abdomen, a rounder face, thin skin and easy bruising, muscle weakness, high blood pressure, diabetes and bone loss. Mild excess from an adrenal nodule is more common than full Cushing’s syndrome and can still affect blood pressure, glucose and bones. Diagnosis relies on tests such as the overnight dexamethasone suppression test, late-night salivary cortisol and 24-hour urine cortisol, interpreted together.
Adrenal insufficiency
When the adrenal glands do not make enough cortisol, from Addison’s disease, pituitary disease or after long-term steroid use, people feel exhausted, lose weight, become dizzy and can become seriously ill during infections. Treatment is daily hydrocortisone with clear sick-day rules and an emergency injection plan, which we teach every patient.
Pheochromocytoma
These rare tumors release adrenaline-type hormones and cause episodes of pounding headache, sweating and palpitations with high blood pressure. Diagnosis is by plasma or urine metanephrines, followed by imaging and surgery.
How we evaluate
| Question | Typical tests |
|---|---|
| Too much cortisol? | 1 mg overnight dexamethasone suppression, late-night salivary cortisol, 24-hour urine cortisol |
| Too little cortisol? | Morning cortisol, ACTH, cosyntropin (ACTH) stimulation test |
| Aldosterone excess? | Aldosterone-to-renin ratio, confirmatory testing, adrenal vein sampling when surgery is considered |
| Pheochromocytoma? | Plasma free or urine fractionated metanephrines |
| Pituitary function? | Prolactin, IGF-1, TSH and free T4, LH/FSH with sex hormones, cortisol; pituitary MRI |
Many of these tests are affected by medicines, timing and how samples are collected. Getting the preparation right the first time avoids repeat testing and false results, so we give written instructions for each.
Common questions
Should I be tested for primary aldosteronism?
Yes if your blood pressure needs three or more medicines, if your potassium is low, if you have an adrenal nodule with high blood pressure, or if high blood pressure began before age 40.
My adrenal nodule was called “benign” on CT. Do I still need blood tests?
Yes. Imaging tells whether a nodule looks benign; only hormone testing tells whether it is making hormones.
Do I need a referral?
Many insurance plans require one. Physicians can refer through our referral page.
Pituitary and adrenal evaluation in San Diego
Seen at our La Jolla, La Mesa and Poway offices. Call (858) 622-7200 or send a request.
Sources: Fassnacht M, et al. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas. Eur J Endocrinol. 2023;189:G1–G42. Funder JW, et al. The Management of Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:1889–1916. Nieman LK, et al. The Diagnosis of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93:1526–1540. Melmed S, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:273–288. Written by Mba Uzoma Mba, MD, PhD; reviewed by Darius A. Schneider, MD, PhD. Reviewed October 2026.
