Non-functioning Tumours and Pituitary Hormone Testing Flashcards
The anterior pituitary is also known as
Adenohypophysis and accounds for about 75% of total weight.
The posterior pituitary is also known as
Neurophypophysis (nerve tissue and axons that originate in the hypothalamus).
Pituitary mass lesions can be
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.
Development of the pituitary gland
Rathke’s pouch.
Describe craniopharyngioma
Arise from squamous epithelial remnants of Rathke’s pouch; can be:
- Adamantinous: cyst formation and calcification
- Squamous papillary: well circumscribed
Is craniopharyngioma malignant or benign?
Benign tumour although infiltrates surrounding structures
What are the peak ages to develop craniopharyngioma?
5-14 y.o., 50-74 y.o.
Describe the appearance of craniopharyngioma?
Solid, cystic, mixed, extends into suprasellar region.
What are the symptoms of craniopharyngioma?
Raised ICP, visual disturbances, growth failure, pituitary hormone deficiency, weight increase
Rathke’s cyst is a remnant of what?
Rathke’s pouch
Describe Rathke’s cysts
Single layer of epithelial cells with mucoid cellular or serous components in cyst fluid.
Presentation and symptoms of Rathke’s cyst
Mostly intrasellar component but may extend parasellarly.
Mostly asymptomatic and small.
Presents with headache and amenorrhoea, hypopituitarism and hydrocephalus.
What is the second most common tumour of the pituitary area?
Meningioma
Meningioma is the complication of what?
Radiotherapy
Meningioma is associated with what?
Visual disturbance (loss of visual acuity and visual field defects) and endocrine dysfunction.
Diagnosis of meningioma?
T1 MRI imaging - similar to grey matter (hypointense to pituitary and enhance with contrast).
Lymphocytic hypophysitis
Inflammation of the pituitary gland due to an autoimmune reaction.
What are the three types of lymphocytic hypohyisits?
Lymphocitic adenohypophysitis (LAH)
Lymphocitic.
infindibuloneurohypophysitis.
Lymphocitic panhypophyisitis.
What is the age of presentation of LAH in women and men?
35 and 45.
Non-functioning pituitary adenoma (NFPA) or silent pituitary adenoma (SPA).
Account for less than 10-15% of primary intracranial tumours.
Most SPA express what?
Gonadotrophins or subunits.
What percentage of SPAs are classified as null cell adenomas?
23%
NFPAs are diagnosed in between what ages?
20-60 in 78% of cases.
Half of NFPAs are
Incindentalomas
