Pituitary Tumours

Question 1

General presentation of pituitary tumours

Answer 1

-Bitemporal hemianopia
-Mass effect (visual loss, seizures, headaches, cranial nerve neuropathies)
-Hypogonadism
-Long-standing and progressive symptoms
-Erectile dysfunction.

Question 2

Investigation in pituitary tumours

Answer 2

-Pituitary blood profile (GH, prolactin, ACTH, FH, LSH, TFT)
-Formal visual field testing
-MRI brain with contrast

Question 3

General management of pituitary tumours

Answer 3

-Trans-sphenoidal surgery
-Somatostatin analogue
-Dopamine agonist.
-Bromocriptine for prolactinoma.

Question 4

Describe prolactinomas

Answer 4

-Galactorrhoea
-Infertility
-Decreased libido
-Sexual dysfunction
-Osteoporosis
-Amenorrhoea
-Hirsutism, acne.
-MRI pituitary decreased pituitary hormones, glucose tolerance, cortisol, sex hormones, insulin-like growth factor 1.

Question 5

Describe macroprolactinomas

Answer 5

-Asymptomatic
-Galactorrhoea
-Amenorrhoea
Infertility.
-PEG precipitation.

Question 6

What are other causes of hyperprolactinaemia

Answer 6

-Primary hypothyroidism (THS elevated)
-Drug-induced: antipsychotics, antidepressants, opiates, cocaine, antihypertensives
-Pregnancy

Question 7

Describe somatotroph adenomas

Answer 7

-Acromegaly: coarse facial appearance, spade-like hands, large tongue, excessive sweating, gigantism, hyperprolactinaemia.
-Trans-sphenoidal surgery, somatostatin analogue.

Question 8

Describe corticotroph adenoma

Answer 8

-Excess ACTH (Cushing’s disease): facial plethora, supraclavicular fullness, menstrual irregularities, central obesity, striae, decreased symptoms, psychiatric symptoms, easy bruisable, weakness.

Question 9

Describe non-functioning adenomas

Answer 9

Generalised hypopituitarism