Pituitary Disease

Question 1

D?

Answer 1

Pituitaryadenomasarebenign tumorsthat often arise sporadically from theanterior pituitary gland. They are classified based on their size as microadenomas or macroadenomas, and whether they producehormonesas secretory (functional) andnon-secretory(non-functioning)adenomas. Secretoryadenomasproduce thepituitaryhormoneof the corresponding cell type, which results in a state ofhyperpituitarism.Non-secretorymacroadenomas, however, destroy the surrounding normalpituitarytissue and result inhypopituitarism.

Question 2

RF?

Answer 2

• Genetic
• MEN-1
• Familial isolated pituitary adenomas
• Carney complex

Question 3

Ddx?

Answer 3

• Craniopharyngioma-cystic and supracellar origin
• Meningioma
• Cerebral mets
• Arachnoid cysts
• Primary hormonal dysfunction

Question 4

Aetiology?

Answer 4

Functional
• Prolactinomas
• Somatotropin adenomas (GH)
• Corticotropic-ACTH adenomas
• Thyrotrophic-TSH
• Gonadotrophic (LH/FSH)

Non-functional
• Macroadenomas
• Microadenomas

Question 5

Cp?

Answer 5

• Mass Effect-
• Non-specific headache, bitemporal hemianopia, cranial nerve palsy, CSF rhinorrhoea, signs of pituitary apoplexy
• Hormonal
• Functional-hypersecretion
• Non-functional-hyposecretion
FEATURES IN ON

Question 6

Pathophysiology?

Answer 6

See table

Question 7

Investigations?

Answer 7

See table

Question 8

Management?

Answer 8

See table

Question 9

Prognosis?

Answer 9

• Hypopituitarism has a 1.8 times higher risk of mortality-CVD risk is higher
Otherwise good prognosis

Question 10

Complications?

Answer 10

• SE of drugs
• Pituitary apoplexy-haemorrhage
• Surgery-include CSF leak and meningitis, bleeding, and endocrine disturbances;diabetes insipidusis an important complication to be aware of due to disruption of the hypothalamic axis with the posterior pituitary.