Pituitary tumours

Question 1

What is the most common pituitary tumour

Answer 1

benign adenoma

Question 2

What are the histological types of pituitary? what hormone does each produce?

Answer 2

1. chromophobe - prolactin, ACTH, GH
2. Acidophil - GH, PRL
3. Basophil - ACTH

Question 3

How can pituitary adenomas be classified?

Answer 3

1. Size - micro adenoma <1cm, macro >1cm

2. hormonal status - secretory/functioning produce hormone to XS, non-secretory/non-functioning doesn’t

Question 4

What is the most common type of pituitary adenoma? whats the next most common?

Answer 4

prolactinoma
then non-secreting adenoma
then GH secreting
then ACTH secreting

Question 5

What different mechanisms can cause sx?

Answer 5

1. Hormone XS
2. Hormone depletion
3. Stretching of dura within/around pituitary fossa - headaches
4. Compression of optic chiasm - bitemporal hemianopia

Question 6

What different presentations do hormone XS cause?

Answer 6

ACTH - Cushings
GH - Acromegaly
Prolactin - galactorrhoea/amenorrhoea

Question 7

What is a pituitary incidentaloma?

Answer 7

when pituitary adenomas, particularly microadenomas, can be an incidental finding on neuroimaging

Question 8

What are the investigations?

Answer 8

1. Pituitary blood profile - prolactin, LH, FSH, TFTs, ACTH, cortisol, GH
2. MRI brain w contrast
3. Formal visual field testing

Question 9

What are the treatment options?

Answer 9

Hormone replacement as needed
Surgery - usually trans-sphenoidal
Radiotherapy - residual or recurrent adenomas
Lifelong follow up 
Discuss fertility

Question 10

What is pituitary apoplexy

Answer 10

Rapid pituitary enlargement from a bleed into a tumour causing mass effects, CV collapse due to acute hypopituitarism and death

Question 11

When should u suspect pituitary apoplexy?

Answer 11

acute onset headache
meningism
reduced GCS
Ophthalmoplegia/visual field defect

Question 12

What is the rx of pituitary apoplexy?

Answer 12

Urgent IV hydrocortisone + flid balance
+/- cabergoline
+/- surgery

Question 13

What are craniopharyngiomas?

Answer 13

tumour originating from Rathke’s pouch

commonest childhood intracranial tumour

Question 14

What is the classical presentation of craniopharyngioma? in children
in adults

Answer 14

In childhood w growth failure

Adults - amenorrhoea, reduced libido, hypothalamic sx or tumour mass effect

Question 15

What is rx of craniopharyngioma?

Answer 15

Surgery +/- post-op radiation

test pituitary function post-op