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Medicine Block - Endocrinology > Pituitary Tumours > Flashcards

Pituitary Tumours Flashcards

1
Q

Pituitary tumours can be divided into size. What are the two sizes?

A

Microadenomas - <1cm

Macroadenomas - >1cm

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2
Q

What are the 3 histological types of pituitary tumour?

A

Chromophobe - most do not secrete anything, some cause hypopituitarism. Some produe prolactin, ACTH and GH. Local pressure effect in 30%

Acidophil - secretes GH or prolactin, local pressure effect is 10%

Basophil - secrete ACTH, local pressure effect is rare

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3
Q

What are the symptoms of pituitary tumours caused by?

A

Local pressure effects

Hormones that may be secreted

Hypopituitarism

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4
Q

What are the features of local pressure?

A
  • Headache
  • Visual loss (bilateral temporal hemianopia due to the compression of the optic chiasm)
  • Pressure/invasion of cavernous sinus –> Palsy of cranial nerves 3, 4, 6
  • Diabetes insipidus
  • Disturbance of hypothalamic centres of temperature, sleep, appetite
  • Erosion through the floor of sella leading to CSF rhinorrhoea
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5
Q

What tests are carried out to diagnose a pituitary tumour?

A

MRI scan
Visual fields assessment
Screening test for the hormones

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6
Q

What is the screening test for growth hormone abnormalities?

A

Glucose tolerance test

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7
Q

What is the screening test for prolactin hormone abnormalities?

A

Basal prolactin blood test

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8
Q

What is the screening test for ACTH hormone abnormalities?

A

Synacthen test

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9
Q

What is the screening test for ADH abnormalities?

A

Water deprivation test

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10
Q

What is the screening test for cortisol abnormalities?

A

Overnight Dexamethasone suppression test

48hr Dexamethasone suppression test

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11
Q

What is the screening test for Thyroid abnormalities?

A

TSH blood test

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12
Q

What is the screening test for LH/FSH abnormalities?

A

LH/FSH blood test

Blood test for oestrogen and testosterone and DHEA

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13
Q

How are pituitary tumours treated?

A
  • Start hormone replacement as needed
  • Ensure steroids are given before thyroxine as thyroxine may precipitate an adrenal crisis
  • Treat each manifestation
  • Surgery –> trans-sphenoidal or trans-frontal approach if there is supra-sellar extension
  • Radiotherapy
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14
Q

What is the post op care for pituitary tumours?

A

Retest pititary function to assess replacement needs

Repeat dynamic tests for adrenal function more than 6 weeks post op

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15
Q

When is radiotherapy best in treating pituitary adenomas?

A

When the adenoma is recurrent or residual

It as good rates of tumour control and normalisation of excess hormone secretion

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16
Q

What is pituitary apoplexy?

A

Pituitary apoplexy or pituitary tumor apoplexy is bleeding into or impaired blood supply of the pituitary gland at the base of the brain. This usually occurs in the presence of a tumor of the pituitary, although in 80% of cases this has not been diagnosed previously.

17
Q

What are the effects of pituitary apoplexy?

A

Mass effect
Cardiovascular collapse due to acute hypopituitarism
Death

18
Q

what are the symptoms of pituitary apoplexy?

A
  • Sudden headache
  • Rapidly worsening visual field defect or double vision caused by compression of nerves surrounding the gland
  • Meningism
  • Decreased GCS
  • Acute symptoms caused by lack of secretion of essential hormones, predominantly adrenal insufficiency.
19
Q

How is pituitary apoplexy treated?

A

Urgent Hydrocortisone 100mg IV
Fluid balance
Cabergoline
Surgery

20
Q

What is a craniopharyngioma?

A

Craniopharyngioma is a rare type of brain tumor derived from pituitary gland embryonic tissue (Rathke’s pouch) that occurs most commonly in children, but also affects adults.

21
Q

How does crainopharyngioma present in children?

A

Children - Growth failure

Adults:

  • Amenorrhoea
  • Decreased libido
  • Hypothalamic symptoms
  • Tumour mass effect
22
Q

How is craniopharyngioma diagnosed?

A

MRI

23
Q

How is craniopharyngioma treated?

A

Surgery and post op radiation

Test pituitary function post op

Medicine Block - Endocrinology (22 decks)

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