Pituitary and Adrenal Surgery -Davis

Question 1

What are the symptoms of increased prolactin in men and women?

Answer 1

amenorrhea and galactorrhea in women

hypogonadiam in men

Question 2

What results from compression of the optic chiasm?

Answer 2

bitemporal hemianopsia

Question 3

What imaging should be done for a pituitary adenoma?

Answer 3

MRI

Question 4

What is the treatment for a prolactinoma? what if it is causing mass effect?

Answer 4

prolactinomas are normally treated with medical therapy

mass effect–> surgery

Question 5

When would a craniotomy be utilized for a pituitary tumor?

Answer 5

large supracellar pit tumor

Question 6

What are some common complications of trans-sphenoidal surgery?

Answer 6

• damage to pituitary gland
• visual loss (damage to optic chiasm)
• DI (damaged post. pit)
• CSF leak
• stroke (damaged carotid AA or cavernous sinus

Question 7

What does the right adrenal vein run into? what about the left?

Answer 7

right=inferior vena cava

left=left renal vein

Question 8

What should be addressed first surgically in an adrenal surgery for pheochromocytoma?

Answer 8

the adrenal vein for control of hormone release

Question 9

What organs are near the right adrenal gland? The left?

Answer 9

right adrenal is behind the liver

left is behind the stomach, near the pancreas and spleen

Question 10

What are the Hounsfield units measuring? What is the HU for adenomas vs pheochromocytomas?

Answer 10

density

100 HU

Question 11

What do benign tumors, adenomas and malignant tumors look like?

Answer 11

Benign tumors are usually round/oval, smooth, and homogenous.

Adenomas have a high fat content and have low density on CT.

Malignant tumors are irregular and non-homogenous

Question 12

What adrenal masses should be surgically resected?

Answer 12

ALL functional tumor (regardless of size)

any lesion > 4 cm

malignant tumors

Question 13

What is the rule of 10s for?

Answer 13

pheochromocytomas (most common tumor of the adrenal medulla)

10% familial
10% extra-adrenal
10% multiple
10% bilateral
10% pediatric
10% malignant

Question 14

What is an MIBG scan?

Answer 14

a nuc med study that takes up the isotope into the adrenal medullar cells allowing for the localization of ectopic positions of pheochromocytomas

Question 15

What is important to give in preparation for a pheochromocytoma surgery? Why?

Answer 15

alpha blockers 1-3 weeks before surgery (phenobenzamine)

beta blockers (propranolol) every 6-8 hours after alpha blockade and hydration

give both to avoid a hypertensive crisis post-operatively

Question 16

What are some possible complications of adrenal surgery?

Answer 16

Bleeding from injury to IVC, renal vessels or surrounding organs.

Injury to surrounding organs.

Tumor embolization

Increased infections and thrombotic complications in patients with Cushing’s syndrome

Adrenal insufficiency

Hemodynamic instability in patients with pheochromocytoma.