LECTURE 3 HYPOPHYSEAL TUMORAL PATHOLOGY

Question 1

HYPOPHYSEAL TUMORAL PATHOLOGY frequency ? Necroptic studies ?

Answer 1

10-15% of intracranial tumors

6-23% asymptomatic hypophyseal tumors.

Question 2

Symptoms of HYPOPHYSEAL TUMORAL PATHOLOGY ?

Answer 2

neurological symptoms (tumoral syndrome)

•functional symptoms (endocrine syndrome)

Question 3

Neurological symptôms of HYPOPHYSEAL TUMORAL PATHOLOGY ?

Answer 3

direct compression

•intracranial hypertension

Question 4

Functional symptoms of HYPOPHYSEAL TUMORAL PATHOLOGY ?

Answer 4

secondary to the alteration of hypophyseal and/or peripheral glands function.

Functional consequences may be:
• secretory deficiency
• secretory excess

Question 5

Hypophyseal fossa

Answer 5

1. SULCUS CHIASMATICUS
   •2. TUBERCULUM SELLAE
   •3. TURKISH SADDLE APERTURE
   •4. POSTERIOR CLINOID PROCESSES
   •5. QUADRILATERAL LAMINA
   •6. DORSUM SELLAE
   •7. ANTERIOR CLINOID PROCESSES
   •8. LAMINA DURA
   •9. SPHENOIDAL SINUS

Question 6

The pituitary gland (hypophysys) the roof

Answer 6

the gland is surrounded by “ dura mater”,
•formed by a reflection of the dura attached to the clinoid processes = the diaphragma sellae.

The optic chiasm lies :
•5-10 mm above the diaphragma sellae and
•anterior to the stalk.

Question 7

Hypophyseal tumors

Answer 7

•most are adenomas
adenocarcinoma
•a rare condition
very invasive.
it may produce: GH, PRL, ACTH

hypophyseal tumors may occasionally be associated to adenomas in other endocrine glands
•Pancreas,
•Parathyroid

= defining Multiple Endocrine Neoplasia syndrome (MEN).

Question 8

FUNCTIONING ADENOMAS
1. SOMATOTROPINOMA

Answer 8

GH secreting adenoma

Question 9

PROLACTINOMA

Answer 9

40% of hypophyseal adenomas

Question 10

CORTICOTROPINOMA

Answer 10

basophilic microadenoma (88-90 %)
•macroadenoma (very rare)- high local invasive potential.
•Reactional corticotropinoma (Nelson’s) –
very agressive macroadenoma
occurs in patients presenting bilateral adrenalectomy for Cushing’s disease
and receiving low or inadequate doses of glucocorticoid therapy.

Question 11

GLYCOPROTEIC HORMONES SECRETING ADENOMAS

Answer 11

GONADOTROPINOMA –
long-evolutive primary hypogonadism
25 % of hypophyseal macroadenomas in men:

Question 12

THYROTROPINOMA less than 1 %

Answer 12

primary thyrotropinoma- secretes TSH that may produce hyperthyroidism – rare
•secondary thyrotropinoma - a reactive hyperplasia of thyrotropic cells as a result
of primary hypothyroidism

Question 13

NONFUNCTIONAL ADENOMAS

Answer 13

Do not present systemic secretory capacity.