In the examination of a patient with resting tremor, the physician checks for rigidity and bradykinesia by flexing and extending the patient's arms, seeking signs of cogwheel rigidity. Tremor and rigidity may become more pronounced if patients perform voluntary movements with the opposite limb (., the patient draws a circle in the air with the opposite hand). The patient is asked to stand and to walk, thus displaying evidence of difficulty initiating movement, reduced arm swing, or shuffling gait. If PD is suspected, a trial of therapy with a dopaminergic agent such as levodopa-carbidopa (Sinemet) is appropriate. Referral to a neurologist is indicated when patients fail to respond to the medication or demonstrate an atypical presentation.
A doctor will test for prolactin blood levels in women with unexplained milk secretion ( galactorrhea ) or irregular menses or infertility , and in men with impaired sexual function and milk secretion. If prolactin is high, a doctor will test thyroid function and ask first about other conditions and medications known to raise prolactin secretion. While a plain X-ray of the bones surrounding the pituitary may reveal the presence of a large macro-adenoma, the small micro-adenoma will not be apparent. Magnetic resonance imaging ( MRI ) is the most sensitive test for detecting pituitary tumours and determining their size. MRI scans may be repeated periodically to assess tumour progression and the effects of therapy. Computed Tomography (CT scan) also gives an image of the pituitary, but it is less sensitive than the MRI.