Pituitary Tumours

Question 1

What type of tumours are Pituitary tumours usually?

Answer 1

Benign adenomas

Question 2

How are Pituitary tumours divided in terms of size? (2 things)

Answer 2

1. Microadenoma = less than 1cm
2. Macroadenoma = more than 1cm

Question 3

How are Pituitary tumours divided in terms of Histology? (3 things)

Answer 3

1. Chromophobe (70%)
2. Acidophil (15%)
3. Basophil (15%)

Question 4

What are the features of different Chromophobe Pituitary tumours? (4 things)

Answer 4

1. Non-secretory (can cause Hypopituitarism)
2. Secrete Prolactin (50%)
3. Secrete ACTH / GH
4. Local pressure effect (30%)

Question 5

What are the features of Acidophil Pituitary tumours? (2 things)

Answer 5

1. Secrete GH / Prolactin
2. Local pressure effect (10%)

Question 6

What are the features of Basophil Pituitary tumours? (2 things)

Answer 6

1. Secrete ACTH
2. Local pressure effect = rare

Question 7

What are the symptoms of Pituitary tumours caused by? (3 things)

Answer 7

1. Local pressure
2. Excessive hormones
3. Hypopituitarism

Question 8

What are the CF of Pituitary tumours caused by Local pressure?

Answer 8

1. Headache
2. Hypothalamic centres disturbance (temp / sleep / appetite)
3. Bitemporal hemianopia (bc pressing on optic chiasm)
4. Cranial Nerve Palsy (3,4,6) (bc pressing /invading Cavernous Sinus)
5. CSF rhinorrhoea (if sellar floor erosion)
6. Diabetes Insipidus

Question 9

What are the CF of Pituitary tumours caused by Excessive hormones? (4 things)

Answer 9

1. Acromegaly
2. Hyperprolactinaemia
3. Cushing’s disease
4. Thyrotoxicosis

Question 10

What investigations should be done for Pituitary tumours? (5 things)

Answer 10

1. MRI (to define intra / supra sellar invasion)
2. Visual fields assessment (if sus optic chiasm pressure)
3. Hormone screening tests
4. Glucose tolerance test (if sus acromegaly)
5. Water deprivation test (if sus diabetes insipidus)

Question 11

What are the treatment options for Pituitary tumours? (5 things)

Answer 11

1. Hormone replacement (if needed)
2. Treat any Cushings / Prolactinoma / Acromegaly
3. Surgery: Trans-sphenoidal (most) (thru nose)
4. Surgery: Trans-frontal (if suprasellar invasion) (thru forehead)
5. Radiotherapy (for Residual / Recurrent tumours)

Question 12

Why is it important steroids are given BEFORE levothyroxine in Pituitary tumour treatment?

Answer 12

Bc thyroxine can cause an adrenal crisis

Question 13

What are the management options Post-Op for pituitary tumours? (2 things)

Answer 13

1. Lifelong follow up (bc high recurrence rate)
2. Discuss fertility (bc can be reduced post-op bc low gonadotropins)

Question 14

What is a complication of Pituitary tumours?

Answer 14

Pituitary apoplexy (rapid pituitary enlargement bc bleed into tumour)

Question 15

What can Pituitary apoplexy lead to? (2 things)

Answer 15

1. CVS collapse bc acute hypopituitarism
2. Death

Question 16

What are the CF of Pituitary apoplexy? (5 things)

Answer 16

1. Acute headache
2. Meningism
3. Low GCS
4. Ophthalmoplegia (extraocular eye muscle paralysis)
5. Visual field defects

Suspect Pituitary apoplexy if you have these CF + a known pituitary tumour

Question 17

What is the management for Pituitary apoplexy? (4 things)

Answer 17

1. Urgent steroids (IV Hydrocortisone 100mg)
2. Fluid balance
3. +/- Cabergoline (if prolactinoma) (dopamine agonist)
4. +/- Surgery

Question 18

What is given to block Prolactin secreting tumours (Prolactinomas)?

Answer 18

Bromocriptine

Bromance to crip da milk lol

Question 19

What is given to block GH secreting tumours?

Answer 19

Somatostatin analogues (e.g ocreotide)

Okrah to stop u from growing hmm