Pituitary Adenoma

Question 1

What is a pituitary adenoma?

Answer 1

They are defined as benign tumours of the pituitary gland

Question 2

What is the most common classification of pituitary tumours?

Answer 2

Pituitary adenoma

Question 3

What are the two classifications mechanisms of pituatary adenomas?

Answer 3

Pituitary Adenoma Size

Pituitary Adenoma Hormonal Status

Question 4

What are the two size classifications of pituatary adenomas?

Answer 4

Microadenomas

Macroadenomas

Question 5

What are microadenomas?

Answer 5

They are defined as pituitary adenomas which are less than 1cm in diameter

Question 6

What are macroadenomas?

Answer 6

They are defined as pituitary adenomas which are greater than 1cm in diameter

Question 7

What are the two hormonal status classifications of pituitary adenomas?

Answer 7

Secretory Adenomas

Non-Secretory Adenomas

Question 8

What is another term for secretory pituitary adenomas?

Answer 8

Functioning pituitary adenomas

Question 9

What are secretory pituitary adenomas?

Answer 9

They are defined as pituitary adenomas which produce excess of a particular hormone

Question 10

What is the most common subclassification of secretory pituitary adenomas?

Answer 10

Prolactinomas

Question 11

How do secretory pituitary adenomas present?

Answer 11

Hyperpituitarism

Question 12

What is another term for non-secretory pituitary adenomas?

Answer 12

Non-functioning pituitary adenomas

Question 13

What are non-secretory pituitary adenomas?

Answer 13

They are defined as pituitary adenomas which don’t produce excess of a particular hormone

Question 14

How do non-secretory pituitary adenomas present?

Answer 14

These tumours lead to compression of the normal functioning pituitary gland, therefore resulting in the presentation of generalised hypopituitarism and pressure effects

Question 15

What are the nine clinical features of pituitary adenomas?

Answer 15

Headaches

Nausea & Vomiting

Bitemporal Hemianopia

Amenorrhea

Galactorrhoea

Decreased Libido

Cushing’s Syndrome Features

Acromegaly Features

Diabetes Insipidus Features

Question 16

What are the three investigations used to diagnose pituitary adenomas?

Answer 16

Blood Tests

Visual Field Testing

MRI Scans

Question 17

What is the first line investigation used to diagnose pituatary adenomas?

Answer 17

Blood Tests

Question 18

What six blood test results indicate a pituitary adenoma?

Answer 18

Increased/Decreased Growth Hormone Levels

Increased/Decreased ACTH Levels

Increased/Decreased Cortisol Levels

Increased/Decreased Prolactin Levels

Increased/Decreased FH/LSH Levels

Increased/Decreased T3/T4/TSH Levels

Question 19

Which pituitary adenoma classification results in hormone hypersecretion blood results?

Answer 19

Secretory pituitary adenomas

Question 20

Which pituitary adenoma classification results in hormone hyposecretion blood results?

Answer 20

Non-secretory pituitary adenoma

Question 21

What visual field test result indiciates pituitary adenoma?

Answer 21

Bitemporal hemianopia

Question 22

What MRI scan result indicates pituitary adenoma?

Answer 22

A hyperdense mass within the sellar region

Question 23

What is the pharmacological management option of pituatary adenomas?

Answer 23

Hormonal Therapy

Question 24

When is hormonal therapy used to manage pituitary adenomas?

Answer 24

It is the first line management option used to manage secretory pituitary adenomas - prolactinomas

Question 25

Name a hormonal therapy used to manage prolactinomas

Answer 25

Bromocriptine

Question 26

What is the surgical management option of pituitary adenomas?

Answer 26

Transsphenoidal Transnasal Hypophysectomy

Question 27

When is transsphenoidal transnasal hypophysectomy used to manage pituitary adenoma?

Answer 27

It is used to manage non-secretory pituitary adenomas in which the following criteria is obtained... - Visual Field Defects - MRI Optic Chiasm Compression - Pituitary Apoplexy & Visual Disturbances - Hypersecreting Adenoma Excluding Prolactinomas

Question 28

What is transsphenoidal transnasal hypophysectomy?

Answer 28

It involves removal of the pituitary adenoma through the sphenoid sinus

Question 29

When is radiotherapy used to manage pitutary adenomas?

Answer 29

Recurrent pituitary adenomas

Question 30

In what two ways is radiotherapy used to manage pituitary adenomas?

Answer 30

To control growth rate To reduce excess hormone secretion

Question 31

What complication is associated with pituitary adenomas?

Answer 31

Pituitary Apoplexy

Question 32

What is pituitary apoplexy?

Answer 32

It is defined as a sudden enlargement of a pituitary tumour secondary to haemorrhage/infarction

Question 33

Which pituitary adenoma classification is most commonly associated with pituitary apoplexy?

Answer 33

Non-secretory macroadenomas

Question 34

What are the four risk factors associated with pituitary apoplexy?

Answer 34

Trauma Hypertension Pregnancy Anticoagulation

Question 35

What are the six clinical features associated with pituitary apoplexy?

Answer 35

Sudden Onset Headache Nausea & Vomiting Neck Stiffness Bitemporal Superior Quadrantic Defect Extraocular Nerve Palsies Hypotension

Question 36

What are the three management options of pituitary apoplexy?

Answer 36

IV Hydrocortisone Fluid Balance Pituitary Surgical Resection

Question 37

What is the first line management option of pituitary apoplexy?

Answer 37

IV Hydrocortisone This should be administered urgently, before diagnostic investigations due to the life-threatening consequences