Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Neurosurgery Basics > Ch. 9 - Pituitary Tumors > Flashcards

Ch. 9 - Pituitary Tumors Flashcards

1
Q

Incidence of pituitary tumors

A

8-10% of all intracranial tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pituitary adenoma origin

A

From anterior lobe (adenohypophysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pituitary adenoma spread and consequences

A

Local invasion inferiorly through floor of sella (CSF rhinorrhea)

Superiorly to suprasellar cisterns (compression of optic chiasm, hypothalamus, 3rd ventricle)

Laterally to cavernous sinus (CN disturbance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lateral microadenomas are more likely to produce which hormones?

A

Prolactin and GH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Microadenoma vs. macroadenoma

A

Micro: < 10mm

Macro: >10mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Central microadenomas are more likely to produce which hormone?

A

ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Effects of prolactin

A

Breast growth and promotion of lactation; important in spermatogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is prolactin secretion regulated?

A

Dopamine blocks prolactin secretion (UNLIKE ALL OTHER PITUITARY HORMONES)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Characteristic presentation of prolactinomas

A

Young females with amenorrhea and galactorrhea; males with impotence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Prolactin level suggestive of pituitary adenoma

A

>2000 ng/mL (nl 70-550)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Other pituitary adenomas associated with hyperprolactinemia

A

GH and null cell can cause hyperprolactinemia 2/2 mass effect blocking DA secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Consequences of ACTH adenoma

A

ACTH stimulates adrenal cortex to secrete cortisol = CUSHING’S DISEASE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Null cell adenoma histology

A

Chromophobic (no cytoplasmic granules) + accumulation of mitochondria (then called ‘oncocytomas’)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Null cell adenoma presentation

A

Aggressive and grow quickly = visual disturbances

Hormonally silent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Factors affecting presentation of pituitary adenomas

A

Size of tumor + endocrine fxn of secreted hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Visual field deficits a/w pituitary adenoma

A

Compression of optic chiasm -> bitemporal hemianopsia

Compression of optic tract -> homonymous hemianopsia

Compression of posterior chiasm -> bilateral central scotomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Extraocular deficits a/w pituitary adenomas

A

CN3, 4, 6 palsies

CN5 damage 2/2 cavernous sinus invasion causes facial pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Sxs of hypopituitarism

A

Pre-pubertal: retards development of 2ndary sex characteristics

Post-pubertal: fatigue, muscle weakness, anorexia –> episodic confusion/drowsiness (severe) can be precipitated by stressful events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Sxs of pituitary apoplexy

A

Spontaneous hemorrhage into pituitary tumor = sudden severe HA, transient LOC + extraocular muscle paralysis (looks like SAH + EOM involvement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do GH-secreting tumors cause?

A

Kids - gigantism

Adults (30-40) - acromegaly (enlarged hands/feet, coarse/greasy skin, sweat profusely, HTN, cardiac hypertrophy, diabetes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cushing’s disease

A

ACTH-producing pituitary adenoma (80% microadenomas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cushing’s disease mortality

A

50% at 5 years

23
Q

Cushing’s disease sxs

A

Obesity, thin skin, striae, fat redistribution (moon face, buffalo hump), easy bruising, acne, facial hair, weakness/muscle atrophy, osteoporosis, glucose intolerance

24
Q

Causes of Cushing’s syndrome

A

90% of cases 2/2 Cushing’s disease (ACTH-producing pituitary adenoma)

OTHER: adrenal adenoma/carcinoma or ectopic ACTH (small cell lung CA)

25
Q

Nelson-Salassa syndrome

A

ACTH-producing pituitary adenoma in pt w/ bilateral adrenalectomy -> no negative feedback -> accelerated growth of existing adenoma (usually macroadenoma)

26
Q

Cutaneous findings of Nelson-Salassa syndrome

A

Hyperpigmentation 2/2 beta-MSH production (ACTH breakdown product)

27
Q

How is GH-secreting tumor diagnosed?

A

Glucose suppression test - measure GH following glucose bolus (should suppress normally)

IGF-1 levels - indicator of GH activity

Other: measure GHRH or TRH

28
Q

How is Cushing’s disease diagnosed?

A
  1. Hypercortisolemia on 24 hr urine cortisol
  2. Dexamethasone suppression test (high-dose will suppress pituitary adenoma but NOT ectopic or adrenal ACTH source)
  3. Administer CRH and measure differential ACTH level in periphery/pertrosal sinus
29
Q

Scan of choice for pituitary adenomas?

A

High resolution CT/MRI with contrast

30
Q

Appearance of pituitary micro vs. macroadenoma on CT?

A

Micro: hypodense, upward bulging, deviation of pituitary stalk, thinning of sella

Macro: contrast-enhancing lesion in sella, best seen on coronal section

31
Q

Appearance of pituitary micro vs. macroadenoma on MRI?

A

Micro: T1 - hypointense T2 - hyperintense

Macro: T1 - isointense T2 - hyperintense

32
Q

Ddx of pituitary adenoma

A

Craniopharyngioma (pituitary gland embryonic tissue) OR suprasellar meningioma (part of sella turcica)

Uncommon: optic nerve/hypothalamus glioma, aneurysm, Rathke’s cleft cysts

33
Q

Indications for surgical excision of pituitary adenomas

A
  1. Large tumors compressing adjacent structures (esp. visual pathways)
  2. GH-secreting (causing acromegaly)
  3. ACTH secreting (causing Cushing’s)
  4. Refractory prolactinomas
34
Q

Surgical approaches to pituitary adenomas

A

Transphenoidal vs. transcranial excision

35
Q

Post-operative management of pituitary excision

A

Fluid balance and hormonal status!

Endocrine deficiency replacement with (1) parenteral hydrocortisone and (2) vasopressin for transient DI

36
Q

Indications for postoperative radiotherapy in pituitary adenomas

A

Subtotal excision or residual hormone secretion

37
Q

Medical tx of micro prolactinomas

A

Bromocriptine = dopamine agonist; significant side effects (n/v, postural hypotension)

38
Q

Craniopharyngioma origin

A

Epithelial remnants of Rathke’s pouch

39
Q

Craniopharyngioma histology

A

Cystic tumor with yellow fluid (cholesterol crystals)

  1. Adamantinous - all children have this type
  2. Papillary - 1/3 of adults, rare in children
40
Q

Craniopharyngioma presentation

A
  1. Elevated ICP (3rd ventricular obstruction) - HA, vomiting, papilledema
  2. Visual impairment - papilledema vs. chiasmal compression (direct)
  3. Endocrine abnormalities - hypogonadism, stunted growth, DI
41
Q

Craniopharyngioma appearance on CT

A

Cystic tumor in suprasellar region with curvilinear calcification

42
Q

DDx of craniopharyngioma

A

Rathke’s cleft cyst

43
Q

Craniopharyngioma tx

A

Pterional craniotomy vs. bifrontal craniotomy (top-down approach since tumor is suprasellar)

44
Q

Empty sella syndrome

A

Communicating extension of subarachnoid space into pituitary fossa

2/2 defect in diaphragma sella OR pituitary surgery/radiotherapy OR increased ICP = herniation of subarachnoid space

Considered ANATOMICAL VARIANT

45
Q

Classic pt with empty sella syndrome

A

Obese, hypertensive, middle-age woman

46
Q

Sxs of empty sella syndrome

A

HA, spontaneous CSF rhinorrhea

47
Q

Tx of empty sella syndrome with CSF rhinorrhea

A

Repair leak in floor of sella with crushed muscle and fascia lata + CSF shunt

48
Q

Anterior pituitary lobe vs. posterior lobe development

A

Anterior lobe - Rathke’s pouch

Posterior lobe - infundibulum (floor of diencephalon)

49
Q

Hormones released by anterior pituitary? Posterior pituitary?

A

Anterior - GH, TSH, ACTH, prolactin, LH, FSH

Posterior - ADH, oxytocin

50
Q

What is the most common pituitary adenoma?

A

Prolactinoma (40%) > GH adenoma (20%) = non-secreting adenoma (20%) > ACTH adenoma (15%)

51
Q

Population most commonly affected by craniopharyngiomas

A

Children and young adults; almost half occur in first 20 years of life

52
Q

Identify the lesion

A

Pituitary macroadenoma

53
Q

Identify the lesion

A

Craniopharyngioma

54
Q

Identify the lesion

A

Empty sella syndrome

Neurosurgery Basics (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions