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Pituitary Adenoma > Background and recommendations > Flashcards

Background and recommendations Flashcards

1
Q

RT dose for nonfunctional unresectable?

A

50.4 Gy at 1. Gy/fx

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2
Q

What are the potential late compications of RT?

A

Blindness
Brain necrosis
Hypopituitarism

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3
Q

What is the dose constraint with using SRS for the optic nerve?

A

8 Gy

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4
Q

When can hormone normalization be expected after RT?

A

It can take months to years

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5
Q

With conventional RT what is the dose tolerance for the optic nerves and chiasm?

A

54 Gy

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6
Q

Fractionated RT dose for functional and non-functional tumors?

A

Functional: 54 Gy at 1.8 Gy/fx

Nonfunctional: 50.4 Gy at 1.8 Gy/fx

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7
Q

What medication can be used for ACTH secreting pituitary tumors?

A

Ketoconazole

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8
Q

When is fractionated RT recommended instead of SRS?

A

Tumor > 3 cm

Tumor 3 mm or less from the chiasm

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9
Q

What agents are used for GH secreting tumors?

A

Somatostatin, octreotide, pegvisomant

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10
Q

What dose will likely result in hypopituitarism?

A

40-45 Gy

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11
Q

What are the typical doses for functional and nonfunctional tumors when using SRS?

A

Nonfunctional: 16 Gy
Functional: 20-25 Gy

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12
Q

When is SRS best for pituitary adenomas?

A

Asymptomatic patient with microadeomas

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13
Q

What is the expected local control for tumors treated with fractionated RT and SRS?

A

LC is over 90% for both treatment

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14
Q

How long does it take medications to normalize prolactin levels in patients with prolactinomas?

A

1-2 months

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15
Q

What is the treatment paradigm for prolactinomas?

A

Start with bromocriptine. 30% of patients can not tolerate it due to nausea, headache and fatigue.

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16
Q

What needs to be done before RT?

A

Discontinue medications for functional adenomas before RT

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17
Q

What are the hormone control rates after RT?

A

GH secretors: 80%
ACTH secretors: 50-80%
Prolactinomas: 30-40%

18
Q

What are the indications for RT?

A
  1. Medically inoperable
  2. Persistent hormone secretion after surgery
  3. S/p only STR or decompression surgery
  4. Recurrent tumor after surgery
19
Q

What are local control rates after transphenoidal surgery?

20
Q

What are some poor prognostic factors for prolactinomas treated with surgery?

A

Size > 2 cm
High preop PL level
Older age
Longer duration of amenorrhea

21
Q

What are some poor prognostic factors for GH secreting tumors treated with surgery?

A

High preop GH and somatomedin C levels
Tumors > 1 cm
Extrasellar extension

22
Q

What type of surgery is needed for tumors that invade the cavernous sinus or frontal/temporal lobes?

A

Frontal craniotomy

23
Q

What is the likelihood of hormone normalization after surgery for a functional tumor?

A

Long term, only 30-40%

24
Q

Definition of picoadenoma, microadeonoma, macroadenoma?

A

Macro: > 1 cm
Micro: 0.3 to 1 cm
Pico: <0.3 cm

25
Q

What is cushing’s syndrome?

A 
Elevated cortisol (adrenal production or exogenous)
Low ACTH
26
Q

What is cushing’s disease?

A

High cortisol caused by high ACTH

27
Q

What is considered a normal level of PL after RT?

A

< 25 ng/mL

28
Q

What is the treatment paradigm for nonfunctional tumors?

A

1a. Surgery followed by observation or RT
or
1b. RT alone

29
Q

What is the treatment for functional tumors?

A
  1. Medications

2. Surgery if progressive +/- RT

30
Q

What are the typical symptoms for patients with prolactinomas?

A

Galactorrhea, Amenorrhea, Decreased libido, infertility

Levels: 20-25 or above

31
Q

Which cranial nerves are found in the cavernous sinus?

A

CN III-IV, V1-2 and VI

32
Q

What autosomal dominant syndrome is associated with pituitary adenomas?

A

MEN1

Pituitary, parathyroid and pancreatic tumors

33
Q

What hormones are secreted by the pituitary and post pituitary adenoma?

A

Anterior: PL, GH, ACTH, TSH, LH, FSH

Posterior: ADH, oxytocin

34
Q

What hormones are secreted by basophilic tumors?

A

ACTH, TSH, LH, FSH

35
Q

What hormones are secreted by acidophilic tumors?

36
Q

What are the most common functional tumors?

A

Prolactinoma 30% > GH 25% > ACTH 15%

37
Q

What are the most common tumors among men and the elderly?

A

Males and elderly: nonfunctioning or GH

38
Q

What are the most common tumors among women?

A

Prolactin and ACTH secreting tumors

39
Q

What percentage of tumors are functional vs. nonfunctional?

A

Functional: 75%
Nonfunctional: 25%

40
Q

What are some heritable syndromes that predispose to pituitary tumors?

A

MEN1 and MEN2

41
Q

What is the histologic description of cells making up nonfunctional tumors?

A

Chromophobic

42
Q

What is the risk of endocrine dysfunction?

Pituitary Adenoma (1 decks)

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