Pituitary Adenomas Flashcards
most primary adenomas arise from any type of cell of the anterior pituitary and lead to what?
increased secretion of hormone(s) produced by that cell
what are 4 major causes of pituitary gland disorders? TIT G
Tumors/hyperplasia
Infarction
Trauma
Genetic Disorders
a pituitary adenoma that is clinically nonfunctioning/silent is most likely a what?
gonadotroph
a pituitary adenoma can result in a decreased secretion of other hormones due to what?
compression of other cell types
how big is a microadenoma?
less than 1 cm
how big is a macroadenoma?
more than 1 cm
impaired peripheral vision in the outer temporal halves of the visual field of each eye
bitemporal hemianopsia
what are 3 visual defects that can be present in a patient with a pituitary adenoma?
bitemporal hemianopsia
decreased acuity
diplopia
a patient presents with headaches that make you suspect a pituitary adenoma. What could be the cause of the headache?
expansion of the sella
Why would a patient with a pituitary adenoma present with hormone deficiencies?
compression
what is the best imaging for most sellar masses/pituitary adenomas?
MRI
what test would we want to order for a patient in which we suspect a pituitary adenoma?
visual acuity + fields
which hormone should be ordered first in a patient if we suspect a pituitary adenoma?
serum prolactin
besides serum prolactin, which other hormones could be checked if a pituitary adenoma is suspected? (6)
IGF-1
24-hr urinary free cortisol
LH
FSH
T4
TSH
what is the first step in the treatment for a pituitary adenoma?
hormonal evaluation to determine the type of adenoma
what is the treatment of choice of a pituitary adenoma that is any type, except lactotroph?
endoscopic transphenoidal hypophysectomy
what is the initial treatment for a lactotroph adenoma?
cabergoline (dopamine agonist)
found on MRIs performed due to other reasons and 10% are found in autopsies
incidentalomas
what should we do if we find an incidentaloma that is larger than 10mm (1cm)?
complete workup
what should we do if a patient has an incidentaloma that is less than 20 mm with a normal workup?
observation
what should we do if we find an incidentaloma that is smaller than 10mm and asymptomatic?
measure serum prolactin concentration
what should we do if we find an incidentaloma that is 2-4mm?
no further testing
what should we do if we find an incidentaloma that is 5-9mm?
annual MRI for 2 years
if stable lesion, MRI q few years
enlarged sella turcica that is not entirely filled with pituitary tissue
empty sella syndrome
what is the cause of empty sella syndrome?
a defect in the diaphragma sella that allows CSF pressure to enlarge the sella
