Pituitary

Question 1

What does chromophobe adenoma mean

Answer 1

• No uptake of dye within the tumourous specimen = non-functioning adenoma

Question 2

What is the most common long-term complication of cranial irradiation?

Answer 2

Growth hormone deficiency

Question 3

Clinical manifestations of growth hormone deficiency in adults

Answer 3

• Change in body composition (increase in fat mass, decrease in lean body mass)
• Decreased bone mineral density in men

Question 4

Features of growth hormone excess (acromegaly) in adults

Answer 4

• Wide, spade-like shaped hands, increased sweating and warmth of palms, thickened skin, osteoarthritic changes in hands, median nerve entrapment
• Proximal myopathy, ulnar nerve thickening, axillae for skin tags, acanthosis nigricans
• Large supraorbital ridge, frontal bossing
• Visual field defect - bitemporal hemianopia in large pituitary tumours, Optic atrophy due to optic nerve compression and papilloedema (due to raised ICP from extensive tumour), angioid streaks due to degeneration/fibrosis of Bruch’s membrane, hypertensive/diabetic changes in fundus
• Large tongue, splayed/separated teeth, malocclusion of jaw, square jaw, prognathism
• Hoarse voice, enlarged thyroid
• Coarse body hair, gynaecomastia, heart for arrhythmias, cardiomegaly, CHF (IHD, HTN, cardiomyopathy all common in acromegaly)
• Kyphosis of back
• Abdomen. hepatic, splenic, renal enlargement. Testicular atrophy (gonadotropin deficiency from enlarging pituitary tumour)
• Lower limbs - signs of hip & knee osteoarthritis, pseudogout. Foot drop from common peroneal nerve entrapment