anterior pituitary disease Flashcards
overall forms of pituitary disease
- non-functioning / silent pituitary adenomas (don’t secrete hormones)
- endocrine active pituitary adenomas
- functional and non-functional pituitary carcinoma
- metastases from elsewhere
- pituitary cysts - rathkes
- developmental abnormalities - craniopharyngioma
RELEVANT
tumors of cns
vascular tumours
vascular aneourthyms
MRI
- preferred imaging for pituitary
- good to visualise soft tissue and vascular structures
- no exposure to ionising radiation
T1
- fat - bright
T2
- structures with high water content eg cycts
CT
THINK C FOR CALCIFIED
- better at visualising bony calcified structures
- calcified tumors such as craniopharyngiomas and meningomas
- useful when patients cannot have an MRI
CT disadvantages
less optimal soft tissue imaging compared to MRI
use of intravenous contrast media
exposure to radiation
what is Craniopharyngioma and the different histological types.
- benign tumour which infiltrates surrounding structures
- solid, cystic, mixed
- extends into suprasellar regions
- arises from squamous epithelial remnants of rathkes pouch
2 types:
adamantinous - cyst formation and calcification
squamous papillary - well circumscribed
peak ages for Craniopharyngioma
5 to 14 years; 50 to 74 years
Craniopharyngioma signs
- raised intercranial pressure
- visual disturbances
- growth failure
- pituitary hormone deficiency
- weight increase
What is craniopharyngioma?
Slow growing benign tumour which compresses the pituaitary gland and optic chiasm leading to symptoms.
Treatment of craniopharyngioma (3)
- Hormone replacement
- Transsphenoidal surgical removal
- Radiotherapy
Pathophysiology of craniopharyngioma (4)
- Squamous epithelial remnants of Rathke’s pouch
- Benign, slow growing tumour infiltrates to surrounding structures
- Mixed solid and cystic parts
- Doesn’t spread to other parts of the body but puts pressure on suprasellar region of skull
Diagnosis of Craniopharyngioma (4)
- CT
- MRI
- Visual Examination
- Endocrine examination
Adamantinous vs squamous papillary craniopharyngioma
Adamantinous: Cyst formation and calcification
Squamous papillary: Well circumscribed
Cause of meningiomas
Complication of radiotherapy
Complications of meningioma (3)
- Loss of visual acuity
- Visual field defects
- Endocrine dysfunction
How common are meningiomas?
2nd most common (first is pituitary adenoma)
non-functioning / silent pituitary adenomas
- dont secrete hormones
- don’t cause major diseases like Cushings ect in the same way that functioning pituitary adenomas do
- account for 25-30% of pituitary adenomas
- prognosis is good
symptoms:
- visual disturbances
- headaches
- hydrocephalus + inc in intercranial pressure
contrast pituitary adenomas and pituitary carcinomas
adenomas:
- benign
- do not metastase
- ones found all throughout this block - cushings, addisons ect
- very relevant for course and exams
carcinomas:
- extremerly rare
- malignant
- have the ability to metastase
- poor prognosis
- dont worry about - havent been taught
