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Head and Neck and CNS > Pituitary gland > Flashcards

Pituitary gland Flashcards

1
Q

location

A

top of the base of skull in a concavity within the sphenoid bone - pituitary fossa.
below the hypothalamus and optic chiasm

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2
Q

where do tumours arise

A

in the anterior portion

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3
Q

what is it split into

A

ant and post halves

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4
Q

are tumours mainly benign or malignant

A

benign
pituitary adenoma, pituitary neuroendocrine

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5
Q

what does the anterior pituitary gland do

A

secrete hormones

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6
Q

what hormones does the anterior secrete

A

FSH
LH
growth hormone
adrenocorticotropic
TSH
prolactin.

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7
Q

what does growth hormone do

A

somatropin
stimulates cell production and regeneration and growth

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8
Q

what does TSH do

A

hypothalamus monitors blood levels for T3/T4
regulates heart rate, respiratory rate, menstrual cycle, weight loss and gain

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9
Q

what does adrenocorticotropic do

A

triggers adrenal gland to produce cortisol

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10
Q

what does FSH do

A

testicular growth, sperm production/ ovulation

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11
Q

what does LH do

A

testosterone release, changes in ovaries to maintain cycle

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12
Q

what does prolactin do

A

helps lactation, escalated levels decrease oestrogen and testosterone levels
in males it enhances testosterone maintaining spermatogenesis

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13
Q

what is the presentation

A

low sex drive
infertility
makes prolactin
less frequent or halted periods
erection difficulty
increased milk production

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14
Q

what are the two types of tumour

A

non functioning/ non secreting [DON’T MAKE HORMONES]
functioning/secreting [DO MAKE HORMONES]

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15
Q

somatroph adenomas

A

acromegaly
growth spurts
overgrown feet + hands

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16
Q

corticotroph adenomas

A

cushings syndrome
weight gain
red and round face
high blood pressure

17
Q

TSH presentation

A

overactive thyroid
weightloss
sweating
shaking
palpitations

18
Q

what is the diagnosis process

A

CT/MRI
blood tests

19
Q

what are the treatment options

A

surgery: hormones are given after
active monitoring: watch and wait, small tumours, drugs can be given to reduce hormone levels for functioning tumours
RT: recurrent or progressive non secreting tumours following surgical excision, residual disease close to optic apparatus, adverse pathological features, secreting tumours with persistent hormone elevation despite hormone blockade, not fit for surgery

20
Q

what is Ki 67

A

proliferation of tumour cells, it is a protein which increases as the cell divides

21
Q

what is the half life for cobalt 60

A

5.26 years
as time goes on treatments would be longer

22
Q

describe the gamma knife process

A

holes = 5-18mm
doors lead lined
positioned in a set position
7am frame fitting
lidocaine into skin
MRI with the frame
tumour size is checked
only CTV

23
Q

what must the volume of tumour be for GK

A

<20 cm^3

24
Q

how long does GK take

A

15 min-4 hours

25
Q

what is a risk of GK

A

skull fracture due to the large amounts of pressure, could cause a CSF leak

26
Q

how many fractions is GK for

A

single

27
Q

what are the risks of GK

A

tiredness, headaches = steroids
hypopituitarism = hormones
new cranial neuropathies: facial numbness, tingling
stroke
secondary malignancies surrounding the brain
simple analgescia
bleeding
skin lacteration
infection at insertion sites
skull fracture

28
Q

what is the dose for secreting tumours to 80% IDL

A

21-25 Gy
> 25Gy to control acromegaly
dose limited by optic apparatus

29
Q

what is the dose for non secreting tumours to 80% IDL

A

16Gy

30
Q

what is the dose for non SRS IMRT

A

45-54Gy in 25-30
proton if under 25
SRS dose = size

31
Q

what are the OAR

A

optic chiasm
lens
brain stem
normal brain
lacrimal gland

32
Q

what does SRS on a linac need

A

a PTV, additional dose is given due to imaging

33
Q

what does SRS depend on

A

type, size, number in brain, location

34
Q

post treatment issues

A

hypopituitarism
hormone production deficiences

35
Q

what isodose line is treatment normally prescribed to

A

80% at 6MV
must achieve target coverage of >99%

small fields and plans using sphere packing could be at 50%

36
Q

what do low prescription lines provide

A

optimal sparing of normal tissue
improved conformity, hot spots increase in target which lead to radionecrosis

37
Q

what isodose line can GK prescribe to

A

any

38
Q

what hormones do posterior secrete

A

vasopressin/ADH: water balance
oxytocin: promotes positive feelings and child birth
[low levels of oxytocin = slow birth]

Head and Neck and CNS (12 decks)

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