Skip survey header

Pituitary Tumor Questionnaire

1. This questionnaire is best completed if you have all of your available records in front of you. You may be prompted to obtain records and studies that are not currently in your possession. You also may be asked to send (upload) documents to UCLA so that they can be part of your electronic medical records. After completing the survey, it may be helpful to print it out so that you can follow-up on the necessary tasks.

Questions related to hormone function
Menstrual Periods
  *This question is required.
  *This question is required.
Interest in sex (libido)
Milk leakage from your breasts
Have you had enlargement of your hands?
Have you had enlargement of your feet?
Carpal tunnel syndrome
Has your voice deepened (not related to puberty)?
Have you noticed more skin tags?
Have you developed increased perspiration?
Do you snore?
  *This question is required.
Have you had a colonoscopy?
  *This question is required.
Have you gained a large amount of weight?
Do you take steroids (hydrocortisone, prednisone, dexamethasone)?
  *This question is required.
Does your skin bruise easily?
  *This question is required.
Do you have skin stretch marks
(such as on your abdomen)?
  *This question is required.
Do you get frequent infections?
  *This question is required.
Do wounds take a long time to heal?
Do you have any psychiatric problems or history?
  *This question is required.
Have you had blood clots in your legs (deep venous thrombosis, or DVT)?
Are you diabetic (diabetes mellitus)?
Do you have high blood pressure?
Do you have any thyroid problems?
  *This question is required.
Are you constantly thirsty and urinating frequently?
Do you have headaches?
Do you have worsening vision?
Have you had prior pituitary tumor surgery?
Have you received medication treatment (pills and/or injections) to lower abnormally high hormone levels caused by your pituitary tumor?
  *This question is required.
Have you received radiation therapy for your pituitary tumor?
Do you take aspirin or blood thinners?
Any blood relatives have a pituitary tumor?
Have you had kidney stones?