Surveys

PDES Patient Survey

Thank you for taking the time to help the PDES gather information that will help us build a resource list for patients and reach physicians who need information about pituitary disorders.

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First Name*

Last Name*

Street Address*

City*

State/Canadian Province*

Postal Code*

Country*

E-Mail Address*

What is your type of pituitary disorder?

Acromegaly

Cushing's

Prolactinoma

Non-secreting/null cell/ or nonfunctioning tumor

Rathke Cleft Cyst

Chraniopharynginoma

Sheehan's Syndrome

Lymphocytic Hypophysitis

Other

What symptoms prompted you to seek medical help?

What symptoms prompted you to seek medical help?

Type of treatment you received for your diagnosis?

Type of treatment you received for your diagnosis?

What medications are you currently taking?

What medications are you currently taking?

Surgery. If so, was it successful in removing all of the tumor cells?

Radiation If so were you treated for any hormone deficiencies?

Which hormones are you deficient in?

TSH

ACTH

FSH

What type of specialist diagnosed your pituitary condition?

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Surveys