Pituitary Tumor 2

Question 1

What are the 2 types of Cushing’s Syndromes?

Answer 1

ACTH dependent

• ectopic ACTH
• ectopic CRF

ACTH independent

• Adrenal adenoma
• adrenal carcinoma
• micro and macronodular hyperplasia

Question 2

What are the clinical features of Cushing’s?

Answer 2

Obesity Central
Buffalo hump
Wasting of Buttocks
Skin: Atrophy of the epidermis: thin skin, easy bruising, striae
Neuropsychiatric: depressed mood and crying, decreased concentration and memory
Proximal myopathy
Osteopaenia: crush fractures and vertebrae
75% of them are glucose intolerance, 25% have diabetes
Hirsutism
HTN, menstrual disorder

Question 3

What is the commonest cause of Cushing’d Syndrome?

Answer 3

Cushing’s Disease

Question 4

How do you investigate for Cushing’s Syndrome?

Answer 4

FBE

• Hb will be high end of normal
• WCC: slightly elevated with low neutrophils

Electrolyte

• hypokalemia
• if ectopic: metabolic alkalosis

Hyperglycemia

Increased Calcium absorption and hypercalciuria

Question 5

How do you diagnose Cushing’s Syndrome?

Answer 5

• 24hour urine free cortisol
• Overnight dexamethasone suppression test
• Imaging of pituitary. If adenoma, likely to be Cushing’s. Can also investigate for adrenal tumour

Question 6

How do you treat Cushing’s SyndromeIf pituitary dependent ?

Answer 6

remove tumour: transphenoidal hypophysectomy

Question 7

How do you treat Cushing’s Syndrome if adrenal adenoma dependent?

Answer 7

Adrenal Surgery

Question 8

How do you treat Cushing’s Syndrome if ectopic ACTH or CRF?

Answer 8

treat the tumour associated with the hormone production

Question 9

What are the causes of sellar masses?

Answer 9

Benign tumour 
Malignant tumour 
Cysts 
Lymphocytic hypophysitis 
Carotid Aneurysm

Question 10

What are the local effects of pituitary tutors?

Answer 10

Headache
Visual dysfunction: commonly bitemporal hemianopia
CN palsy, temporal lobe epilepsy
CSF Rhinorrhea