Pituitary adenoma

Question 1

What are pituitary adenomas?

Answer 1

Benign tumors that often arise sporadically from the anterior pituitary gland.

Question 2

How are pituitary adenoma classified?

Answer 2

(Microadenoma ≤ 10 mm vs macroadenoma > 10 mm)
or
(Functional vs non-functional)

Question 3

What are the risk factors of pituitary adenoma?

Answer 3

Most occur spoaradically

Some associated with Multiple endocrine neoplasia type 1

Question 4

What are the types of functional pituitary adenomas and what hormones do they produce?

Answer 4

Lactotroph adenoma (prolactinoma) - Hyperprolactinemia
Somatroph adenoma - ↑ Growth hormone → acromegaly/gigantism
Corticotroph adenoma (Cushing’s disease) - ↑ ACTH → secondary hypercortisolism
Thyrotroph adenoma - ↑ TSH → secondary hyperthyroidism

Question 5

How are pituitary adenomas diagnosed?

Answer 5

(pituitary blood profile) including: GH, IGF-1, prolactin, ACTH, FH, LSH and TFTs
(Perimetry) Assess visual fields
(Contrast MRI)

Question 6

What are some general clinical features of pituitary adenoma?

Answer 6

(Mass effect) headache, bitemporal hemianopsia, diplopia

Clinical features of hormones excess

Question 7

What is the treatment for pituitary adenomas?

Answer 7

(Prolactinoma) First-line: dopamine agonists (e.g., cabergoline, bromocriptine)
Second-line: transsphenoidal hypophysectomy ± adjuvant radiotherapy

(Non-functioning microadenoma) No treatment

(Remaining adenomas) transsphenoidal hypophysectomy or irradiation

Question 8

What are the differential diagnosis for pituitary adenoma?

Answer 8

pituitary hyperplasia
craniopharyngioma
meningioma
brain metastases
lymphoma
hypophysitis
vascular malformation