Pituitary tumours

Question 1

What is a pituitary adenoma?

Answer 1

Benign tumour of the pituitary gland

Question 2

How can pituitary adenomas be classified?

Answer 2

Size - micro <1cm and macro >1cm

Hormonal status - functioning/secretory or non-functioning/non-secretory

Question 3

Prolactinoma - how does it present?

Split into women, men and generally.

Answer 3

Women:
- Amenorrhea
- Galactorrhea
- Infertility
- Osteoporosis

Men:
- Impotence
- Loss of libido
- Galactorrhoea

Generally w/ pit tumour:
- headache
- visual disturbances —> bitemporal hemianopia
- S+S hypopituitarism

Question 4

Acromegaly - how does it present?

Answer 4

Large hands and feet
Outward growth of jaw and head with gaps between teeth and macroglossia/big tongue
Headaches
ED
Voice changes
Increased sweating + oil skin due to sweat gland hypertrophy
Mood disturbances
Fatigue

Question 5

Cushing’s disease - how does it present?

Answer 5

Muscles: Proximal myopathy, thin limbs

Skin changes and appearance: Striae, bruising, acne, hirsutism, moon face, thin skin, at pads - inter scapular, supraclavicular .

Bones: Osteoporosis /osteopenia

CVS and Endo: DM, HTN
DM

Sexual health and MH: impotence, psych issues

Electrolytes: Hypokalaemia

Question 6

What hormone is secreted in prolactinomas?

Answer 6

Excess prolactin

Question 7

Complications of acromegaly?

Answer 7

Visual field defects
Hypopituitarism
OSA
T2DM
Arthritis
Carpal tunnel
HTN
IHD
Cerebrovascular disease
CCF

Question 8

How do pituitary adenomas typically cause symptoms?

Answer 8

Excess of a hormone
Depletion of hormone
Stretching of the dura within/around pit fossa = headaches
Compress optic chiasm = bitemporal hemianopia

Question 9

Investigations for suspected pituitary tumour?

Answer 9

Pituitary blood profile = GH, prolactin, ACTH, FSH, LH, TFTs.
Visual field testing
MRI brain with contrast

Question 10

Differential Dx for pit tumour?

Answer 10

Pituitary hyperplasia
Meningioma
Brain mets
Lymphoma
Vascular malformation e.g. aneurysm

Question 11

Visual field defect common with pit tumour?

Answer 11

Bitemporal hemianopia

Question 12

What fibres are affected in visual field defect: Bitemporal hemianopia?

Answer 12

Nasal fibres at the optic chiasm

Question 13

Treatment options for pit tumour?

Answer 13

Hormonal therapy
Surgery - transsphenoidal transnasal hypophysectomy
Radiotherapy

Question 14

First line treatment for acromegaly?

Answer 14

Trans-sphenoidal surgery

Question 15

Treatment for acromegaly pit tumour if inoperable?

Answer 15

Treat it medically:
- somatostatin analogue = will inhibit release of GH. E.g: Octreotide

• Pegvisomant = GH receptor antagonist. Subcut admin once a day.
• dopamine agonist = E.g. Bromocriptine

Question 16

Treatment for prolactinoma?

Answer 16

Dopamine agonist - bromocriptine, carbergoline.

If ^ not work/ can not be tolerated = trans-sphenoidal surgery

Question 17

Mechanism of action of bromocriptine (for prolactinoma)?

Answer 17

Dopamine agonist - this inhibits release of prolactin from pituitary gland