PitNET/Adenomas-Clinical Consideration Flashcards
Most primary pituitary tumors are benign and arise from anterior pituitary gland (adenohypophysis). About 50% of pituitary tumors are less than 50 mm at the time of diagnosis, and these may be difficult to find at the time of surgery. What is the size of microadenomas?
● A. Less than 5 mm
● B. Less than 1 cm
● C. Less than or equal to 1 cm
● D. Less than 8 mm
● E. Any size with no mass effects
B. Less than 1 cm
PitNETs arise from the six adenohypophyseal cell types. These comprise 10% of intracranial tumors and peak incidence is in the 3rd and 4th decades of life. What are the most common pituitary tumors?
● A. Prolactinomas
● B. Cortisol producing pituitary tumors
● C. Nonfunctioning PitNETs
● D. Lactotroph tumors
● E. Somatotroph tumors
C. Nonfunctioning PitNETs
A PitNET without cell type specific differentiation based on immunohistochemistry, transcription factors, and negative PAS stain constitutes of 5 to 30% of surgically resected adenomas. These account for 5 to 30% of surgically resected adenomas and typically occur after the age of 60 years. What are
these tumors called?
● A. Null cell tumor
● B. Nonfunctioning adenomas
● C. Undifferentiated adenomas
● D. Acidophil stem cell tumor
● E. Mature PIT1-lineage tumor
A. Null cell tumor
Most PitNET/adenomas are sporadic and arise from a somatic mutation of single progenitor cells. However, PitNET may also occur as part of syndromes including which of the following?
● A. Multiple endocrine adenomatosis or neoplasia
● B. Carney complex
● C. Familial isolated pituitary adenoma
● D. McCune-Albright syndrome
● E. All of the above
E. All of the above
A patient presents with bitemporal hemianopia, hydrocephalus, ptosis, facial pain, diplopia, CSF rhinorrhea, and headache (possibly because of increased intrasellar pressure). On imaging, it comes out to be pituitary macroadenoma causing
mass effects and panhypopituitarism on investigations. Which pituitary hormone becomes decreased first in this case?
● A. Growth hormone
● B. Gonadotropins (LH, FSH)
● C. TSH
● D. ACTH
● E. Prolactin
A. Growth hormone
A patient presents with sudden onset of headache, visual disturbance, and loss of consciousness. A plain CT of the brain was done which showed hemorrhagic mass in sella turcica. CTA was done to rule out aneurysmal bleed which came out to
be positive. MRI showed it to be a case of pituitary apoplexy. What is the recommended management for this condition?
● A. Hydrocortisone 100 to 200 mg IV bolus followed by 2 to 5 mg/h IV bolus
● B. Rapid decompression within 7 days with transcranial or transsphenoidal approach
● C. Complete removal of tumor is usually not necessary
● D. Ventricular drainage for hydrocephalus is generally required
● E. All of the above
E. All of the above
A women presents with amenorrhea-galactorrhea syndrome (also known as Forbes-Albright syndrome, also known as Ahumadadel Castillo syndrome), infertility, and bones mass loss. What is the most common secretory adenoma?
● A. Gonadotropin secreting tumor
● B. Prolactinoma
● C. Growth hormone secreting tumor
● D. Cortisol secreting tumor
● E. None of the above
B. Prolactinoma
A patient presents with increasing hand and foot size, frontal bossing, prognathism, cardiac arrythmias, hypertension, glucose intolerance, peripheral nerve entrapment syndrome, joints pain, and sleep apnea. Brain imaging with endocrine
tests, cardiology consult, and colonoscopy was done in this patient, and surgery is planned for removal of tumor. What is the suggested criteria for biochemical cure of acromegalic patient?
● A. Normal IGF1 level
● B. Growth hormone level less than 5 ng/mL
● C. Growth hormone nadir less than 1 ng/mL after OGST
● D. No residual tumor on MRI of brain
● E. A, B, and C
E. A, B, and C
A patient presents with buffalo hump like shape, striae over lower abdomen, hyperpigmentation, osteoporosis, and generalized muscle wasting. On lab findings, there was elevated 24-hour urine free cortisol, failure to suppress cortisol with low dose (1 mg) dexamethasone test, normal or elevated ACTH, and hyperglycemia. These tumors constitute 10 to 12% of pituitary adenomas. What is the most likely tumor?
● A. Gonadotrophins
● B. Growth hormone producing tumor
● C. Prolactinomas
● D. ACTH secreting tumor
● E. TSH secreting tumor
D. ACTH secreting tumor
Nonfunctioning pituitary tumors present with mass effect and constitute 15 to 30% pituitary tumors (most common pituitary tumors). These tumors are mostly derived from which cells?
● A. Gonadotroph cells
● B. Lactotroph cells
● C. Somatotroph cells
● D. Thyrotroph cells
● E. Acidophil stem cells
A. Gonadotroph cells
Predominant secretion of prolactin over GH is seen in which of the following subtype of PIT1 lineage tumors?
● A. Mammosomatotroph tumor
● B. Mature PIT1 lineage tumor
● C. Lactotroph tumor
● D. Immature PIT1 lineage tumor
● E. Acidophil stem cell tumor
E. Acidophil stem cell tumor
Pituitary tumors represent what percentage of intracranial tumors?
● A. 2%
● B. 5%
● C. 10%
● D. 20%
● E. 30%
C. 10%
A 40-year-old male presented with sudden severe headache, visual disturbance, and loss of consciousness. A better improvement in ophthalmoplegia can be achieved in pituitary
apoplexy if surgery is performed within what time?
● A. 7 days
● B. 10 days
● C. 14 days
● D. 21 days
● E. 1 month
A. 7 days
A 35-year-old female presents with amenorrhea and decreasing vision. Radiology shows pituitary macroadenoma with gross destruction of sellar floor. What is the modified Hardy’s (Wilson’s) classification grade?
● A. I
● B. II
● C. III
● D. IV
D. IV
A 30-year-old female with amenorrhea was referred by endocrinologist to your clinic. What is the most common cause of secondary amenorrhea in women of reproductive potential?
● A. Prolactinoma
● B. OCPs
● C. Pregnancy
● D. Forbes Albright syndrome
● E. Ovarian cysts
C. Pregnancy
