basics

Question 1

location of pituitary

Answer 1

sella turcica of sphenoid

Question 2

sizing terminology

Answer 2

<1cm microadenomas
>1cm macroadenomas
>5cm giant adenoma (rare

Question 3

clinical presentation

Answer 3

often found incidentally on imaging

bitemporal hemianopsia

Question 4

workup

Answer 4

CBC, CMP, TSH, T3/T4, ACTH, 24h urine cortisol, prolactin, T1 post-contrast MRI (look on coronal views
Adenomas hypo intense since less vascular than normal pituitary
skeletal survey if acromegaly

Question 5

COP GEM

Answer 5

differential for pituitary adenoma

Question 6

better prognosis with..

Answer 6

gross total resection (GTR)

Question 7

staging?

Answer 7

no formal staging system

Question 8

prolactinoma

Answer 8

surgery if 1)visual field deficit 2) want to become pregnant

Question 9

Cushing’s txt

Answer 9

1st line is surgery, RT if recurrence, RT preferred over medical management

Question 10

acromegaly txt

Answer 10

1st line is surgery

for those failing surgery 50-60% show reduced GH levels w medical management

Question 11

pituitary carcinoma

Answer 11

rare, survival 2 years, TMZ is 1st line, frequently metastasize

Question 12

non-functioning

Answer 12

surgery is first line

Question 13

treatment paradigm

Answer 13

observe if no symptoms or lab abnormalities

surgery 1st line for most (not for carcinomas)

Question 14

surgical approaches

Answer 14

transphenoidal surgery (TSS)- 95% of cases

Question 15

radiation

Answer 15

SRS preferred as faster to hormone normalization
tox: fatigue, hair loss, hypo-pit, rare vision or hearing loss)
14-20Gy for nonsecretory, 20 or higher for secretory, can also use fractionated SRS
fractionated RT” 45/25 for nonsecretory, 50.4-54 for secretory
Kotecha, ISRS Guidelines- >90% LC at 5 years for either approach, most common tox is hypopit (21%)