Pituitary Disease - Pituitary Tumours

Question 1

What is Pituitary Apoplexy?

Answer 1

A sudden enlargement of a pituitary tumour (usually a non-functioning macro adenoma), secondary to haemorrhage or infarction.

Question 2

Precipitating Factors of Pituitary Apoplexy (4).

Answer 2

1. Hypertension.
2. Pregnancy.
3. Trauma.
4. Anticoagulation.

Question 3

Clinical Features of Pituitary Apoplexy.

Answer 3

1. Sudden-Onset Headache (like SAH).
2. Vomiting.
3. Neck Stiffness.
4. Bitemporal Superior Quadrantic Defect.
5. Extraocular Nerve Palsies.
6. Features of Pituitary Insufficiency.

Question 4

Investigation of Pituitary Apoplexy.

Answer 4

MRI is diagnostic.

Question 5

Management of Pituitary Apoplexy (3).

Answer 5

1. Urgent Steroid Replacement - Loss of ACTH.
2. Careful Fluid balance.
3. Surgery.

Question 6

Classification of Pituitary Adenomas (2).

Answer 6

1. Size - Macro vs. Micro.

2. Hormonal Status - Secretory/Functioning vs. Non-Secretory/Functioning.

Question 7

Commonest Types of Pituitary Adenomas (4).

Answer 7

1. Prolactinomas.
2. Non-Secretory Adenomas.
3. GH-Secreting.
4. ACTH-Secreting.

Question 8

Pathophysiology of Pituitary Adenomas.

Answer 8

1. Excess Hormone.
2. Depletion of Hormone (Non-Functioning Tumours).
3. Stretching of Dura Around Pituitary Fossa (Headache).
4. Compression of Optic Chiasm (Bitemporal Hemianopia).

Question 9

Investigations of Pituitary Adenomas (3).

Answer 9

1. Pituitary Blood Profile.
2. Formal Visual Field Testing.
3. MRI Brain with Contrast.

Question 10

Management of Pituitary Adenomas (3).

Answer 10

1. Hormonal Therapy.
2. Surgery if Progression in Size - Trans-Sphenoidal Resection.
3. Radiotherapy.