Pituitary Adenomas

Question 1

what is the definition of pituitary adenoma?

Answer 1

growth or tumour on the pituitary gland

Question 2

what is the epidemiology of pituitary adenomas?

Answer 2

Increasing in incidence, quite common, around 16.7% in autopsies

Question 3

what is the aetiology of pituitary adenomas?

Answer 3

can run in families, no proven hereditary factors

Question 4

what are the risk factors for pituitary adenomas?

Answer 4

People with a family history of certain hereditary conditions, such as multiple endocrine neoplasia, type 1 (MEN 1), have an increased risk of pituitary tumours. In MEN 1, multiple tumours occur in various glands of the endocrine system. Genetic testing is available for this disorder.

Question 5

what is the pathophysiology of pituitary adenomas?

Answer 5

Pressure on local structures, pressure on normal pituitary, functioning tumour (hyperpituitarism). Cause of uncontrolled cell growth unknown

Question 6

what are the key presentations of pituitary adenomas?

Answer 6

Some may not cause symptoms, signs and symptoms reflect the pressure they put on other structures

Question 7

what are the signs of pituitary adenomas?

Answer 7

Pressure: - Can be fatal - particularly in regards to cortisol deficiency 
- In males: 
• Pale, no body hair (takes 9 months to occur), central obesity 
• Effeminate skin 
- In females: 
• Loose body hair 
• Sallow complexion 
Hormone level: 
ACTH: cushing’s 
GH: acromegaly
Prolactin: prolactinoma
TSH: hyperthyroidism

Question 8

what are the symptoms of pituitary adenomas?

Answer 8

Pressure: headache, vision loss
Hormone deficiency: nausea, weakness, coldness, period disruption, sexual dysfunction, polyuria, weight loss
Hormone overproduction: 
ACTH: cushing’s 
GH: acromegaly
Prolactin: prolactinoma
TSH: hyperthyroidism

Question 9

what are the first line investigations for pituitary adenomas?

Answer 9

MRI

Question 10

what are the gold standard investigations for pituitary adenomas?

Answer 10

Visual field testing, hormone level testing

Question 11

what are the differential diagnoses for pituitary adenomas?

Answer 11

On the basis of seizure, visual disturbance, and constitutional symptoms, pituitary adenoma must be differentiated from oligodendroglioma, meningioma, hemangioblastoma, astrocytoma, schwannoma etc.

Question 12

how are pituitary adenomas managed?.

Answer 12

Surgery, radiotherapy, medication to shrink

Question 13

how are pituitary adenomas monitored?

Answer 13

Size of tumour monitored regularly, MRIs

Question 14

what are the complications of pituitary adenomas?

Answer 14

Hormonal hypersecretion.
Pituitary hormone deficiency (Hypopitutiarism) 
Neurological problems.
Headache.
Bleeding (pituitary apoplexy)

Question 15

what is the prognosis of pituitary adenomas?

Answer 15

The prognosis of pituitary adenomas depends on whether they being functioning or non-functioning. The non-functioning adenomas and prolactinomas have an excellent prognosis if treated promptly with surgery and/or medical therapy.
The most dangerous consequence of pituitary dysfunction is the loss of cortisol, which can be life-threatening, with symptoms such as low blood pressure, confusion, nausea, vomiting and fever.