Non-functioning tumours and pituitary hormone testing Flashcards
The anterior pituitary is made of g_____ tissue and accounts for __% total weight of pituitary
glandular, 75%
What is the structure that develops into the pituitary gland?
Rathke’s pouch (from ectoderm at top of mouth, more like glandular tissue)
Posterior pituitary from excess tissue above, more like neural tissue)
Craniopharyngioma (connective, benign neoplasm)
Arise from squamous epithelial remnants of Rathke’s pouch
Benign tumour but infiltrates surrounding structures. Extends into suprasellar region
Symptoms of craniopharyngioma
Raised ICP (intracranial pressure)
Visual disturbances
(Think hypothyroidism)
Growth failure
Pituitary hormone deficiency
Weight increase
Rathke’s cyst
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
Signs of Rathke’s cyst
Mostly asymptomatic
Headache
Amenorrhoea
Hypopituitarism
Hydrocephalus (fluid accumulates in brain)
Meningioma can arise due to a complication of r_____
radiotherapy
In what 3 scenarios will surgery be done to remove a pituitary adenoma
Causing visual problems
Cushing’s Disease
Acromegaly
(if having headaches, only 50% chance surgery will help with this so consideration required)
How do meningioma patients usually present?
loss of visual acuity, endocrine dysfunction and visual field defects
Lymphocytic Hypophysitis
Inflammation of hte pituitary gland due to an autoimmune reaction:
Lymphocytic adenohypophysitis
Lymphocytic infindibuloneurohypophysitis
Lymphocytic panhypophysitis
What does hypointense mean when imaging?
Decreased signal intensity, shows as darker, area of low water content or different tissue content, can show calcification
What does hyperintense mean when imaging?
Increased signal intensity, shows as brighter, can be area of high water content or inflammation
In T1 imaging (MRI), fluids appear ____ and is useful for anatomical detail and structural visualisation
dark
In T2 imaging (MRI), fluids appear ____ making it useful for showing oedemas or tumours
brighter
Non-functioning pituitary adenoma (NFPA) are mostly diagnosed between ages of __-__
20-60
Signs of aggressive NFPA
Large size
Cavernous sinus invasion
Lobulated suprasellar margins
What are the effects of a local mass in pituitary
Visual field defects
Cranial nerve palsy
Temporal Lobe Epilepsy
Headaches
CSF rhinorrhoea
For non-functioning pituitary tumours what should you test?
Normal pituitary function
If eyesight threatened, or tumour is quickly growing then undergo trans-sphenoidal surgery
What would testing show in primary hypothyroid?
Raised TSH
Low FT4
What would testing show in hypopituitary?
Low FT4 with normal or low TSH
What would testing in Graves’ disease show?
High FT4
Suppressed TSH
What would a TSHoma testing show? (rare)
High Ft4 with normal or high TSH
What would testing show in hormone resistance?
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)
What would testing show in primary Hypogonadism in a man?
Low T (testosterone), raised LH/FSH
What would testing (LH/FSH/testosterone) show in hypopituitary male
Normal or low LH/ FSH and Low testosterone
Anabolic use causes what to happen to levels of testosterone
Low testosterone and suppressed LH
What time of day should you measure testosterone levels?
9am
What test should be taken for patients showing signs of Cushing’s disease?
Dexamethasone suppression test
What is the preferred imaging for hte pituitary?
MRI (better for soft tissue and vascular structures than CT)
