Non-functioning tumours and pituitary hormone testing

Question 1

The anterior pituitary is made of g_____ tissue and accounts for __% total weight of pituitary

Answer 1

glandular, 75%

Question 2

What is the structure that develops into the pituitary gland?

Answer 2

Rathke’s pouch (from ectoderm at top of mouth, more like glandular tissue)

Posterior pituitary from excess tissue above, more like neural tissue)

Question 3

Craniopharyngioma (connective, benign neoplasm)

Answer 3

Arise from squamous epithelial remnants of Rathke’s pouch
Benign tumour but infiltrates surrounding structures. Extends into suprasellar region

Question 4

Symptoms of craniopharyngioma

Answer 4

Raised ICP (intracranial pressure)
Visual disturbances
(Think hypothyroidism)
Growth failure
Pituitary hormone deficiency
Weight increase

Question 5

Rathke’s cyst

Answer 5

Derived from remnants of Rathke’s pouch
Single layer of epithelial cells with mucoid, cellular or serous components in cyst fluid
Mostly intrasellar, may extend parasellar

Question 6

Signs of Rathke’s cyst

Answer 6

Mostly asymptomatic
Headache
Amenorrhoea
Hypopituitarism
Hydrocephalus (fluid accumulates in brain)

Question 7

Meningioma can arise due to a complication of r_____

Answer 7

radiotherapy

Question 7

In what 3 scenarios will surgery be done to remove a pituitary adenoma

Answer 7

Causing visual problems
Cushing’s Disease
Acromegaly

(if having headaches, only 50% chance surgery will help with this so consideration required)

Question 8

How do meningioma patients usually present?

Answer 8

loss of visual acuity, endocrine dysfunction and visual field defects

Question 9

Lymphocytic Hypophysitis

Answer 9

Inflammation of hte pituitary gland due to an autoimmune reaction:

Lymphocytic adenohypophysitis

Lymphocytic infindibuloneurohypophysitis

Lymphocytic panhypophysitis

Question 10

What does hypointense mean when imaging?

Answer 10

Decreased signal intensity, shows as darker, area of low water content or different tissue content, can show calcification

Question 11

What does hyperintense mean when imaging?

Answer 11

Increased signal intensity, shows as brighter, can be area of high water content or inflammation

Question 12

In T1 imaging (MRI), fluids appear ____ and is useful for anatomical detail and structural visualisation

Answer 12

dark

Question 13

In T2 imaging (MRI), fluids appear ____ making it useful for showing oedemas or tumours

Answer 13

brighter

Question 14

Non-functioning pituitary adenoma (NFPA) are mostly diagnosed between ages of __-__

Answer 14

20-60

Question 15

Signs of aggressive NFPA

Answer 15

Large size
Cavernous sinus invasion
Lobulated suprasellar margins

Question 16

What are the effects of a local mass in pituitary

Answer 16

Visual field defects
Cranial nerve palsy
Temporal Lobe Epilepsy
Headaches
CSF rhinorrhoea

Question 17

For non-functioning pituitary tumours what should you test?

Answer 17

Normal pituitary function

If eyesight threatened, or tumour is quickly growing then undergo trans-sphenoidal surgery

Question 18

What would testing show in primary hypothyroid?

Answer 18

Raised TSH
Low FT4

Question 19

What would testing show in hypopituitary?

Answer 19

Low FT4 with normal or low TSH

Question 20

What would testing in Graves’ disease show?

Answer 20

High FT4
Suppressed TSH

Question 21

What would a TSHoma testing show? (rare)

Answer 21

High Ft4 with normal or high TSH

Question 22

What would testing show in hormone resistance?

Answer 22

High FT4 with normal or high TSH (making T4 but body doesn’t respond to it, so more TSH is produced to make more T4)

Question 23

What would testing show in primary Hypogonadism in a man?

Answer 23

Low T (testosterone), raised LH/FSH

Question 24

What would testing (LH/FSH/testosterone) show in hypopituitary male

Answer 24

Normal or low LH/ FSH and Low testosterone

Question 25

Anabolic use causes what to happen to levels of testosterone

Answer 25

Low testosterone and suppressed LH

Question 26

What time of day should you measure testosterone levels?

Answer 26

9am

Question 27

What test should be taken for patients showing signs of Cushing’s disease?

Answer 27

Dexamethasone suppression test

Question 28

What is the preferred imaging for hte pituitary?

Answer 28

MRI (better for soft tissue and vascular structures than CT)