Pituitary tumours

Question 1

What type of pituitary adenomas can you get

Answer 1

non-functional - asymptomatic, do not release hormones

functional - release hormones
usually
acromegaly, prolactinoma,cushings disease

also can compress other parts of pituitary

Question 2

What investigation are required for non-functional adenomas

Answer 2

bloods to check all hormones
pituitary MRI

Question 3

What is management for non-functional adenomas

Answer 3

microadenoma- <1cm

macroadenoma >1cm with no mass effect - observation and evaluation for surgery and HRT

macroadenoma with mass effect - transsphenoidal surgery and HRT

Question 4

What is hyperprolactinemia

Answer 4

increased prolactin from tumour
suppresses GnRH pulsatility
decreased LH and FSH

Question 5

What does hyperprolactinemia lead to in men

Answer 5

reduced testosterone and spermatogenesis in men

Question 6

What does hyperprolactinemia lead to in women

Answer 6

reduced oestrogen and progesterone

Question 7

What are causes of hyperprolactinaemia

Answer 7

pregnancy
breastfeeding
prolactinoma
primary hypothyroidism - TRH normally stimulates prolactin release

Question 8

What may someone with hyperprolactinemia present with

Answer 8

infertility/subfertility
osteoporosis
mass effect
Men - ED, hypogonadism, gynaecomastia , reduced hair growth

Women - galactorrhoea, secondary amenorrhoea

Question 9

What investigations are required for someone with hyperprolactinemia

Answer 9

pregnancy test
TFTs

basal serum prolactin >6000mU/L

pituitary MRI confirms diagnosis

Question 10

What is the management for hyperprolactineamia

Answer 10

Dopamine receptor agonist
-CABERGOLINE
reduce prolactin secretion/tumour size- especially pre-surgery

Transsphenoidal surgery
Sellar radiotherapy

Question 11

What is acromegaly

Answer 11

excess GH secretion

Question 12

How does acromegaly present

Answer 12

insidious onset and slow progression- delayed diagnosis

headache and active sweating
skin changes
joint pain
deepening of voice
large prominent facial features

Question 13

What is diagnostic tests for acromegaly

Answer 13

IGF-1 will be raised
Oral glucose tolerance test - as glucose load should suppress GH

Question 14

What is the first line treatment for acromegaly

Answer 14

trans-sphenoidal surgery

Question 15

What is the first line diagnostic test for acromegaly

Answer 15

serum IGF-1- it will be raised