Pituitary adenoma

Question 1

Describe the size of a microadenoma vs macroadenoma

Answer 1

Micro- <1cm
Macro- ≥1cm

Question 2

What is meant by a secretory/functioning adenoma?

Answer 2

produces an excess of a particular hormone

Question 3

What is the most common type of pituitary adenoma?

Answer 3

Prolactinoma

Then non-secreting adenomas, GH-secreting and then ACTH-secreting adenomas

Question 4

Describe the 4 ways in which pituitary adenomas can cause symptoms

Answer 4

1) Hormone excess
> Cushing’s, Acromegaly, Galacctorhoea

2) Hormone Depletion
> compression of normal functioning pituitary gland
> hypopituitarism

3) Stretching dura matter around the pituitary fossa
> causes headache

4) Compressing optic chiasm
> bitemporal hemianopia

Question 5

If you suspect a patient may have a pituitary adenoma, how can you investigate for this?

Answer 5

• pituitary blood profile
  (GH, prolactin, ACTH, FSH, LSH and TFTs)
• visual field testing
• MRI brain with contrast

Question 6

What differential diagnoses could you consider?

Answer 6

pituitary hyperplasia
craniopharyngioma
meningioma
brain metastases
lymphoma
hypophysitis
vascular malformation (e.g. aneurysm)

Question 7

Treatment of Pituitary Adenoma

Answer 7

• hormonal therapy (dependent on type of tumour)
• Transsphenoidal surgery
• Radiotherapy