Pituitary Tumours ☺️

Question 1

Types of possible tumour

Answer 1

Non functioning adenoma
Functioning adenoma
Carcinoma (malignant epithelial cells)

Question 2

General presentation of pituitary tumours

Answer 2

Headache
Bitemporal hemianopia
Hormone imbalance
Apoplexy => ICP symptoms, SAH mimic

Question 3

Presentation of prolactinomas

Answer 3

MOST COMMON
Female - galactorrhea, amenorrhea
Males - impotence, libido loss, infertility

Question 4

Presentation of GH secreting pituitary adenomas

-complications

Answer 4

Gigantism before puberty
Acromegaly in adults

Skeletal and soft tissue overgrowth =>

• Coarse facial features
• Spade hands
• Increased shoe size
• Big tongue, increased interdental space
• Increased sweat, oily skin

HTN
DM
cardiomyopathy
Colorectal cancer

Question 5

Presentation of Cushing’s disease

Answer 5

ACTH overproduction
-hyperpigmentation

High cortisol

• central weight gain
• osteoporosis, depression, thin skin
• proximal muscle wasting
• hirsutism, acne
• immunosuppression

High aldosterone
-HTN

High androgens
-amenorrhea, impotence, low libido

Question 6

Presentation of increased

• TSH
• LH, FSH

Answer 6

TSH => hyperthyroidism

LH, FSH => can be asymptomatic

Question 7

Presentation of hypopituitarism (non functioning adenoma)

Answer 7

Low ACTH => low cortisol, aldosterone
-fatigue, low BP

Low GH => growth delay, fatigue

Low LH, FSH => amenorrhea, libido loss, infertility

TSH => cold, myxodema, entrapment neuropathy, dry skin, brittle nails

Question 8

Management

• medical
• surgical
• interventional

Answer 8

Mass effect, visual changes => urgent endoscopic transphenoidal removal

Hormonal imbalance
-PRL => dopamine agonist (cabergoline, bromocriptine)
-acromegaly => dopamine agonist, somatostatin analogue (octreotide), GH antagonist (pegvisomant)
-Cushings => adrenal steroid synthesis antagonist (ketoconazole, metyrapone)
Elective surgery

Radiotherapy, radiosurgery

Question 9

Presentation of pituitary apoplexy

-management

Answer 9

SAH MIMIC
Sudden onset headache
N+V
Meningism

Bitemporal hemianopia/visual changes
3rd, 6th nerve palsy

INITIAL - CORTISOL => reduce swelling and 2ndary adrenal insufficiency

DEFINITIVE IF MASS EFFECT- surgical removal of pituitary

If no mass effect, manage with hormone replacement and consider surgery

Question 10

Describe the pathophysiology behind an Addisonian crisis

Answer 10

Cortisol too low
-hypoglycemia

-increased fluid loss from kidneys => electrolyte imbalance, hypovolemia, low BP

Lead to shock => coma => death