The best treatment strategy is surgical excision of the tumor. Residual disease can be managed by medical or radiotherapy.

How do you manage prolactinoma in pregnancy?

A case-based approach is warranted. Serum prolactin measurement cut-offs change. Regular monitoring of MRI and perimetry is needed and those with pressure on chiasma and visual symptoms are managed with cabergoline with close supervision and shared decision-making.

Discuss the management of hypopituitarism.

There is a need for judicial replacement of deficient hormones and regular monitoring of evolving hormone deficiency, as the case may be. It is important that glucocorticoid axis, if deficient, be treated first and then other hormone deficiencies, as any, be corrected.

How commonly do you see lymphocytic hypophysitis? How is it managed?

An individual practice may see 1 case every 3 months or so and high volume centers will see more numbers. Treatment is corticosteroids, correction of underlying hormone deficiencies on case-to-case basis and investigations pertaining to possible causes.