Pituitary tumours

Question 1

Epidemiology

Answer 1

10% of intracranial tumours

Question 2

Size classification

Answer 2

Size

Microadenoma: <1cm Macroadenoma: >1cm

Question 3

Pathology

Answer 3

Many are non-secretory
~50% produce PRL
Others produce GH or ACTH

Question 4

Mass effects

Answer 4

Headache
Visual field defect: bitemporal hemianopia
CN palsies: 3, 4, 5, 6 (pressure on cavernous sinus)
Diabetes insipidus
CSF rhinorrhoea

Question 5

Hormone effects

Answer 5

PRL galactorrhoea, ↓libido, amenorrhoea, ED
↑PRL → ↓GnRH → ↓LH/FSH GH → acromegaly
ACTH → Cushing’s Disease

Question 6

Ix

Answer 6

MRI
Visual field tests
Hormones: PRL, IGF, ACTH, cortisol, TFTs, LF/FSH Suppression tests

Question 7

Medical Rx

Answer 7

Replace hormones

Treat hormone excess

Question 8

Surgical Rx

Answer 8

Trans-sphenoidal excision
Pre-op hydrocortisone
Post-op dynamic pituitary tests

Question 9

Radiotherapy

Answer 9

stereotactic

Question 10

Pituitary apoplexy

Answer 10

Rapid pituitary enlargement due to bleed into a tumour
Mass effects
Headache, meningism, ↓GCS
Bitemporal hemianopia
Cardiovascular collapse due to acute hypopituitarism

Question 11

Pituitary apoplexy Rx

Answer 11

Rx: urgent hydrocortisone 100mg IV

Question 12

What is a Craniopharyngeoma

Answer 12

Originates from Rathke’s pouch
Commonest childhood intracranial tumour
→ growth failure
Calcification seen on CT/MRI