A4- Pituitary Gland

Question 1

Hormones in the anterior lobe and posterior lobe?

Answer 1

Anterior lobe:1. Prolactin

2. ACTH
3. TSH
4. GH
5. LH
6. FSH

Posterior lobe:

1. Vasopressin
2. Oxytocin

Question 2

Answer 2

Question 3

Classification of pituitary adenomas by pathology is

Answer 3

Question 4

Examples of pituitary tumours?

Answer 4

• Pituitary adenoma
• Craniopharyngioma
• Meningioma
• Hypothalamic astrocytoma/glioma

Question 5

Pituiatry adenoma

Presenting symptoms due to

Answer 5

1. Hormonal dysfunction
   • Underproduction (hypopituitarism)
   • Hormonal hypersecretion
2. Local tumour growth and pressure effect

Question 6

Hypopituitarism

What deficiencies does it include?

Answer 6

• GH deficiency
• Gonadotrophin deficiency: loss of libido, loss of secondary sexual characteristics, menstrual dysfunction, ED
• ACTH deficiency: hypocortisolism
• TSH deficiency: secondary hypothyroidism
• Vasopressin deficiency: diabetes insipidus

Question 7

Ix for pituitary

Basal hormone measurement?

Answer 7

• Prolactin
• TSH, fT3 and fT4.
• Cortisol, ACTH
• LH, FSH, tesosterone or oetsradiol
• IGF1

Question 8

Ix for pituitary

Dynamic hormone measurement

Answer 8

• TRH stimulation
• GnRH stimulation
• Glucagon test
• Dexamethasone suppression test
• Oral glucose tolerance test with GH measurement

Question 9

Cushing’s syndrome symptoms/presentation?

Answer 9

• Moon facies
• Facial plethora
• Supraclavicular fat
pads
• Buffalo hump
• Truncal obesity
• Weight gain
• Purple striae
•Proximal muscle weakness
•Easy bruising
•Hirsutism
•Hypertension
•Osteopenia
•Diabetes mellitus/IGT
• Impaired immune
function/poor wound healing

Question 10

Cushing’s syndrome vs. Cushing’s disease

Answer 10

• Cushing’s syndrome is a syndrome due to excess cortisol
from pituitary, adrenal or other sources (exogenous
glucocorticoids, ectopic ACTH, etc.)

• Cushing’s disease is hypercortisolism due to excess
pituitary secretion of ACTH (about 70% of cases of
endogenous Cushing’s syndrome)

Question 11

Medical management of pituitary tumours

Answer 11

Which pharmacologic option to choose depends on
type of tumor:
• Dopamine agonists: bromocriptine, cabergoline- most
useful for prolactinomas, less useful for GH secreting
adenomas
• Somatostatin analog (Octreotide, Octreotide LAR)-most useful for acromegaly
• Pegvisomant (GH receptor blocker)- useful in
acromegaly refractory to somatostatin analogues
• Other: ketoconazole, metyrapone, mitotane- for
Cushing’s disease- use limited by side effects, expense and lack
of efficacy

Question 12

Indications for intervention pituitary tumours

Answer 12

• Tumour growth on imaging
• Hormonal hypersecretion
• Visual field defects

Question 13

Pituitary surgery options?

Answer 13

Transphenoidal approach:
used for 95% of pituitary tumors

Question 14

Indications for Surgery for Pituitary tumours

Answer 14

• Surgery is the first-line treatment of symptomatic pituitary adenomas.
• Useful when medical or radiotherapy fails
• Surgery provides prompt relief from excess hormone secretion and mass effect.
• Indicated in pituitary apoplexy with compressive symptoms

Question 15

Complications of Transsphenoidal
Surgery

Answer 15

Question 16

Pituitary tumours

Indications for radiotherapy

Answer 16

• Incomplete resection of tumours
• Progressive disease after surgery
• Recurrent tumours

Question 17

Pituitary tumours

Genetic predisposition?

Answer 17

• MEN type 1 syndrome
• Familial isolated pituitary adenoma (FIPA)

Question 18

Most common • Enteropancreatic tumours?

Answer 18

Gastrinoma 40%

Question 19

Most common Anterior pituitary tumours

Answer 19

Prolactinoma

Question 20

What is Pituitary apoplexy

Answer 20

Apoplexy means bleeding into an organ or loss of blood flow to an organ. Pituitary apoplexy is commonly caused by bleeding inside a noncancerous (benign) tumor of the pituitary. These tumors are very common and are often not diagnosed. The pituitary is damaged when the tumor suddenly enlarges.