Pituitary Tumour

Question 1

Signs and symptoms of a Pituitary Tumour

Answer 1

· Headache

· Chiasmal Syndrome

· Diabetes insipidus

· Visual disturbances, such as loss of peripheral vision (giving you ‘tunnel vision’) or (rarely) double vision

· loss of libido or erectile dysfunction in men

· menstrual period irregularities in women

· changes to appearance

· cognitive difficulties, including problems with thinking

· persistent headaches

· nausea and vomiting

· light-headedness on standing up

· Fatigue

· Decreased visual acuity

· RAPD

· Visual field loss (usually Bitemporal hemianopia)

· Optic nerve swelling or optic nerve pallor

Question 2

What is chiasmal sydrome?

Answer 2

Chiasmal syndrome is the set of signs and symptoms that are associated with lesions of the optic chiasm, manifesting as various impairments of the sufferer’s visual field according to the location of the lesion along the optic nerve.

Question 3

What is diabetes insipidus?

Answer 3

A disorder of salt and water metabolism marked by intense thirst and heavy urination.
Diabetes insipidus occurs when the body can’t regulate how it handles fluids. The condition is caused by a hormonal abnormality and isn’t related to diabetes.
In addition to extreme thirst and heavy urination, other symptoms may include getting up at night to urinate, or bed-wetting.
Depending on the form of the disorder, treatments might include hormone therapy, a low-salt diet and drinking more water.

Question 4

DDx’s of pituitrary tumours?

Answer 4

· 3rd, 4th or 6th Nerve palsy

· Compressive optic neuropathy (other lesions affecting visual pathway)

· Optic nerve sheath meningioma

· Glaucoma

. Meningioma

. Craniopharyngioma

Question 5

Management of pituitary tumours?

Answer 5

Immediate management

· Confirmation of visual field defect with automated visual field testing (perimetry)

· Neuro-imaging – the best option is MRI

· Referral for endocrinological work-up. Some hormone secreting tumours respond to medical therapy e.g bromocriptine for prolactinoma

· Referral to neuro-surgery for removal of pituitary tumour if required

Long term management

· Follow up visual field testing on regular basis, along with repeat imaging to exclude recurrence

· May require radiotherapy

Question 6

VF result of a unilateral central scotoma, what are your DDx’s?

Answer 6

Unilateral suggests the lession is before the optic chiasm or pre chiasmal. If it's not full unilateral vision loss suggests the cuase is at the retina.
Conditions include:
- optic neuritis 
- AMD
- retinal detachment
- diabtes, hypertension
- cataract
ect

Question 7

VF result bilateral hemianopia, where would the lesion be located? and what can cause this?

Answer 7

The lession would be located at the optic chiasm as nerve fibres cross here.

• pituitrary tumour
• meningiomas
• craniopharyngiomas

Question 8

VF result of a left contralateral homonymous hemianopia, where could the lession be?

Answer 8

The lession could be located at the right optic tract, right optic radtiation (would have to be affecting all 6 paths) magno and parvocellular. The whole calcarine fissure.

Question 9

VF result of a left contralateral superior quadrantopia, where would the lession be located?

Answer 9

right optic radiations, (3 outter most fibers 2 magno 1 parvo), or lower bank of the calcarine fissure.

Question 10

VF result of a left contralateral inferior quadrantopia, where would the lession be located?

Answer 10

Right optic radiations, 3 inner most fibres. upper bank of the calcarine fissure.

Question 11

Contralateral homonymous hemianopia with macular sparing, where would the lession be located?

Answer 11

Posterior cerebral artery is occluded,