Current RMA Instruments

Changes from previous Instruments

SOP Bulletin 181

ICD Coding

• ICD-9-CM Codes: 194.30, 227.30, 237.00
• ICD-10-AM Codes: C75.1, D35.2, D44.3

Brief description

This SOP covers both benign and malignant primary neoplasms of the pituitary. Most such neoplasms are benign pituitary adenomas.

Confirming the diagnosis

Tumours can be identified on MRI or CT scanning, but confirmation requires histological examination from excision or biopsy of the tumour.  Hormone levels (from blood testing) can give an indication of the tumour type.  

The relevant medical specialist is a neurosurgeon or endocrinologist.

Additional diagnoses covered by these SOPs

• Gonadotroph adenoma
• Pituitary adenoma
• Pituitary adenocarcinoma (very very rare)

Conditions excluded from these SOPs:  

• Carcinoid of pituitary^# 
• Craniopharyngioma^#
• Hodgkin’s lymphoma of pituitary*
• Non-Hodgkin lymphoma of the pituitary*
• Secondary neoplasm of the pituitary - code to primary site
• Soft tissue sarcoma of the pituitary*

* another SOP applies

^#  non-SOP

Clinical onset

The condition may be found incidentally on imaging performed for another reason.  The most common symptomatic presentation is visual defects from pressure on the optic nerve.  There may be other neurologic symptoms or symptoms of pituitary hormone deficiency.

Clinical worsening

If untreated the tumour will typically slowly enlarge and become symptomatic or there will be progression of symptoms.  Surgery +/- radiotherapy is the mainstay of treatment.  Hormone replacement therapy may be required.  Ongoing monitoring for recurrence is usually undertaken.