pituitary neoplasia Flashcards
PITUITARY ADENOMAS: Indications for Interventive Therapy (4)
- hypopituitarism
- mass effects
- hypersecretion
- pituitary apoplexy
NONFUNCTIONING PITUITARY ADENOMA Presentation (4)
- headache
- visual field abn
- cranial nerve abn.
- hypopituitarism
NONFUNCTIONING PITUITARY ADENOMA Treatment
surgery is the primary method and with some radiotherapy and pharmacotherapy
HYPERPROLACTINEMIA IN WOMEN most common presentation
amenorrhea and galactorrhea
HYPERPROLACTINEMIA IN MEN most common presentation however In contrast to women, most men present with _______________, often with headache and visual symptoms in addition to hypogonadism.
loss of libido/ hypogonadism
often present with macroadenomas
Don’t just put patient on pharmacologic therapy without exploring cause.
yep
prolactinomas express dopamine D2 receptors
yep
CABERGOLINE
treatment of prolactinomas by binding to D2 receptor
X-LAG seen in pediatric population with gigantism in children due to duplication of __________________________ expressed on X chromosome. Some adults also found with mutation of GPR101.
G-protein-coupled receptor
Alpha-subunit of the stimulatory G protein (GNAS gene or gsp oncogene) (low GTPase activity) conferring constitutive activation of cyclic AMP
acreomegaly what have increased?
both elevated GH and IGF-1
dopamine agonist in acromegaly
some effect with IGF-1 normalized (not tumor shrinkage)but it is limited by side effects
release of ACTH from the pituitary
cushing sydnrome
treatment of cushing’s disease
- transsphenoid microsurgery- very good for microadenomas
- radiation therapy
- bilateral adrenalectomy
_____________ usually distinguishes tumor from cyst.
Architectural complexity
___________ are non-secretory, often suprasellar and consist of architecturally complex arrangements of squamous, cuboidal, and columnar cells and keratinous debris.
Craniopharyngiomas
Pituitary adenomas arise in the _____________(or rarely in pharyngeal pituitary remnant), are homogeneous and usually grow in diffuse sheets
adenohypophysis
Treatment of _____________ may include surgery, radiation and medications to inhibit cortisol synthesis (ketoconazole), ACTH secretion (somatostatin analogues) or block the glucocorticoid receptor (mifepristone)
Cushing’s disease
If one has a clinical suspicion for Cushing’s syndrome based on history and physical, initial testing may include a 1 mg ____________ suppression test, 24 hour urinary cortisol or nighttime salivary cortisol. If initial testing suggests Cushing’s, an _______ should be done
dexamethasone suppression test
If initial testing suggests Cushing’s, an ACTH level should be done
Cushing’s syndrome can be subtle in most cases but can lead to significant morbidity due to the chronic effects of cortisol excess on the body.
yep
Acromegaly is uncommon but can cause an increase in mortality. __________ level may be diagnostic if elevated for age and gender. A __________ test to assess for GH suppression is often done for confirmation. Treatments include surgery, radiation, somatostatin a
IGF-1 level may be diagnostic if elevated for age and gender.
A glucose tolerance test to assess for GH suppression is often done for confirmation.
_____________ are the most common secretory adenomas and are usually treated medically with dopamine agonists (primarily cabergoline).
Prolactinomas
The vast majority of pituitary neoplasms are _______________ . About one third of pituitary __________ are clinically silent. Treatment may not be needed unless the ________ is causing a clinical syndrome or is causing local symptoms such as compression of the optic chiasm or cavernous sinus invasion with cranial nerve deficits.
benign adenomas
In addition to pituitary tumors, ______________ may be related to pregnancy, several medications especially those which block dopamine, primary hypothyroidism, liver disease, kidney disease and other situations.
hyperprolactinemia
