Non-functioning Tumours and Pituitary Hormone Testing

Question 1

The anterior pituitary is also known as

Answer 1

Adenohypophysis and accounds for about 75% of total weight.

Question 2

The posterior pituitary is also known as

Answer 2

Neurophypophysis (nerve tissue and axons that originate in the hypothalamus).

Question 3

Pituitary mass lesions can be

Answer 3

Non-functioning pituitary adenomas (silent).

Endocrine active pituitary adenomas.

Malignant pituitary tumours: functional and non-functional pituitary carcinomas.

Metastases in the pituitary (breast, lung, stomach, kidney).

Pituitary cysts: Rathke’s cleft cyst, mucocoeles, others.

Developmental abnormalities: craniopharyngioma (occasionally intrasellar), germinoma.

Primary tumours of the CNS: perisellar meningioma, optic glioma.

Vascular tumours: hemangioblastoma.

Malignant systemic disease: Hodgkin’s disease, Non-Hodgkin’s lymphoma, leukaemic infiltration, histiocytosis X.

Granulomatous disease: neurosarcoidosis, Wegner’s granulomatosis, tuberculosis, syphilis.

Vascular aneurisms.

Question 4

Development of the pituitary gland

Answer 4

Rathke’s pouch.

Question 5

Describe craniopharyngioma

Answer 5

Arise from squamous epithelial remnants of Rathke’s pouch; can be:

• Adamantinous: cyst formation and calcification
• Squamous papillary: well circumscribed

Question 6

Is craniopharyngioma malignant or benign?

Answer 6

Benign tumour although infiltrates surrounding structures

Question 7

What are the peak ages to develop craniopharyngioma?

Answer 7

5-14 y.o., 50-74 y.o.

Question 8

Describe the appearance of craniopharyngioma?

Answer 8

Solid, cystic, mixed, extends into suprasellar region.

Question 9

What are the symptoms of craniopharyngioma?

Answer 9

Raised ICP, visual disturbances, growth failure, pituitary hormone deficiency, weight increase

Question 10

Rathke’s cyst is a remnant of what?

Answer 10

Rathke’s pouch

Question 11

Describe Rathke’s cysts

Answer 11

Single layer of epithelial cells with mucoid cellular or serous components in cyst fluid.

Question 12

Presentation and symptoms of Rathke’s cyst

Answer 12

Mostly intrasellar component but may extend parasellarly.

Mostly asymptomatic and small.

Presents with headache and amenorrhoea, hypopituitarism and hydrocephalus.

Question 13

What is the second most common tumour of the pituitary area?

Answer 13

Meningioma

Question 14

Meningioma is the complication of what?

Answer 14

Radiotherapy

Question 15

Meningioma is associated with what?

Answer 15

Visual disturbance (loss of visual acuity and visual field defects) and endocrine dysfunction.

Question 16

Diagnosis of meningioma?

Answer 16

T1 MRI imaging - similar to grey matter (hypointense to pituitary and enhance with contrast).

Question 17

Lymphocytic hypophysitis

Answer 17

Inflammation of the pituitary gland due to an autoimmune reaction.

Question 18

What are the three types of lymphocytic hypohyisits?

Answer 18

Lymphocitic adenohypophysitis (LAH)
Lymphocitic.

infindibuloneurohypophysitis.

Lymphocitic panhypophyisitis.

Question 19

What is the age of presentation of LAH in women and men?

Answer 19

35 and 45.

Question 20

Non-functioning pituitary adenoma (NFPA) or silent pituitary adenoma (SPA).

Answer 20

Account for less than 10-15% of primary intracranial tumours.

Question 21

Most SPA express what?

Answer 21

Gonadotrophins or subunits.

Question 22

What percentage of SPAs are classified as null cell adenomas?

Answer 22

23%

Question 23

NFPAs are diagnosed in between what ages?

Answer 23

20-60 in 78% of cases.

Question 24

Half of NFPAs are

Answer 24

Incindentalomas

Question 25

Half of macroadenomas have what?

Answer 25

Visual disturbances and headaches.

Question 26

What are the sign of an aggressive NFPA?

Answer 26

Large size
Cavernous sinus invasion
Lobulated suprasellar margins

Question 27

Pituitary dysfunction can be due to (3)?

Answer 27

Tumour mass effects.

Hormone excess.

Hormone deficiency.

Question 28

What are the investigations of pituitary dysfunction?

Answer 28

Hormonal tests.

If these are abnormal or there is a tumour mass effect -> MRI.

Question 29

Local mass effects can cause:

Answer 29

Visual field defects
Headaches
CSF Rhinorrhoea
Cranial nerve palsy and temporal lobe epilepsy

Question 30

Chiasmal compression from pituitary tumour leads to

Answer 30

Bitemporal hemianopia

Question 31

Non-functioning tumours are diagnosed…

Answer 31

No specific test but absence of hormone secretion .

Test normal pituitary function.

Trans-sphenoidal surgery if threatening eyesight or progressively increasing in size.

Question 32

Why testing pituitary function complex?

Answer 32

Many hormones.

May have deficiency in one or all and may be borderline.

Circadian rhythms and pulsatile.

Question 33

What is the guiding principle of testing pituitary function?

Answer 33

If the peripheral target organ is working normally, the pituitary is working.

Question 34

In primary hypothyroidism, the test shows…

Answer 34

Raised TSH and low FT4 (free thyroid).

Question 35

In hypopituitarism, the TSH and FT4 is

Answer 35

Low TSH
Low or normal FT4

Question 36

In Graves’ disease (toxic) TSH and ft4

Answer 36

TSH suppressed and high FT4

Question 37

In TSHoma (very rare) TSH and FT4

Answer 37

High TSH
Normal or high FT4

Question 38

In hormone resistance the TSH and FT4

Answer 38

High or normal TSH
High FT4

Question 39

What do we measure in pituitary disease?

Answer 39

Free T4