Pituitary Adenomas

Question 1

most primary adenomas arise from any type of cell of the anterior pituitary and lead to what?

Answer 1

increased secretion of hormone(s) produced by that cell

Question 2

what are 4 major causes of pituitary gland disorders? TIT G

Answer 2

Tumors/hyperplasia
Infarction
Trauma
Genetic Disorders

Question 3

a pituitary adenoma that is clinically nonfunctioning/silent is most likely a what?

Answer 3

gonadotroph

Question 4

a pituitary adenoma can result in a decreased secretion of other hormones due to what?

Answer 4

compression of other cell types

Question 5

how big is a microadenoma?

Answer 5

less than 1 cm

Question 6

how big is a macroadenoma?

Answer 6

more than 1 cm

Question 7

impaired peripheral vision in the outer temporal halves of the visual field of each eye

Answer 7

bitemporal hemianopsia

Question 8

what are 3 visual defects that can be present in a patient with a pituitary adenoma?

Answer 8

bitemporal hemianopsia
decreased acuity
diplopia

Question 9

a patient presents with headaches that make you suspect a pituitary adenoma. What could be the cause of the headache?

Answer 9

expansion of the sella

Question 10

Why would a patient with a pituitary adenoma present with hormone deficiencies?

Answer 10

compression

Question 11

what is the best imaging for most sellar masses/pituitary adenomas?

Answer 11

MRI

Question 12

what test would we want to order for a patient in which we suspect a pituitary adenoma?

Answer 12

visual acuity + fields

Question 13

which hormone should be ordered first in a patient if we suspect a pituitary adenoma?

Answer 13

serum prolactin

Question 14

besides serum prolactin, which other hormones could be checked if a pituitary adenoma is suspected? (6)

Answer 14

IGF-1
24-hr urinary free cortisol
LH
FSH
T4
TSH

Question 15

what is the first step in the treatment for a pituitary adenoma?

Answer 15

hormonal evaluation to determine the type of adenoma

Question 16

what is the treatment of choice of a pituitary adenoma that is any type, except lactotroph?

Answer 16

endoscopic transphenoidal hypophysectomy

Question 17

what is the initial treatment for a lactotroph adenoma?

Answer 17

cabergoline (dopamine agonist)

Question 18

found on MRIs performed due to other reasons and 10% are found in autopsies

Answer 18

incidentalomas

Question 19

what should we do if we find an incidentaloma that is larger than 10mm (1cm)?

Answer 19

complete workup

Question 20

what should we do if a patient has an incidentaloma that is less than 20 mm with a normal workup?

Answer 20

observation

Question 21

what should we do if we find an incidentaloma that is smaller than 10mm and asymptomatic?

Answer 21

measure serum prolactin concentration

Question 22

what should we do if we find an incidentaloma that is 2-4mm?

Answer 22

no further testing

Question 23

what should we do if we find an incidentaloma that is 5-9mm?

Answer 23

annual MRI for 2 years
if stable lesion, MRI q few years

Question 24

enlarged sella turcica that is not entirely filled with pituitary tissue

Answer 24

empty sella syndrome

Question 25

what is the cause of empty sella syndrome?

Answer 25

a defect in the diaphragma sella that allows CSF pressure to enlarge the sella