Pituitary Adenoma

Question 1

how can a pituitary adenoma be classified by size?

Answer 1

• microadenoma: <1cm
• macroadenoma: >1cm
• giant adenoma: >4cm (e.g. prolactinoma)

Question 2

what are the symptoms of a pituitary adenoma?

Answer 2

• mass effect (e.g. headache, VFD, cranial nerve palsy)
• hormonal (e.g. hypo- or hypersecretion of prolactin, ACTH, GH, FSH, LH, or TSH)
• rhinorrhoea (e.g. CSF)
• pituitary apoplexy

Question 3

what are the investigations for a pituitary adenoma?

Answer 3

• MRI/CT
• serum prolactin
• IGF-1
• 24-hour urinary cortisol
• plasma ACTH
• short synacthen test
• LH
• FSH
• TFTs

Question 4

what is the conservative management of a pituitary adenoma?

Answer 4

• hormone replacement (e.g. pituitary adenoma with hyposecretion)
• D₂ receptor agonist (e.g. cabergoline) - prolactinoma
• somatostatin analogue (e.g. ocreotide) - GH-secreting adenoma

Question 5

what is the surgical management of a pituitary adenoma?

Answer 5

• transsphenoidal
• stereotactic radiosurgery (e.g. ‘gamma knife’)

Question 6

what is pituitary apoplexy?

Answer 6

• a rare endocrine emergency caused by haemorrhage or infarction within the pituitary gland, often in the presence of a pituitary adenoma
• characterised by sudden onset of symptoms like severe headache, visual disturbances, and sometimes altered mental status
• typically involves corticosteroid replacement to address potential hormone deficiencies, and in many cases, surgical removal of the pituitary tumour