Pituitary Tumours

Question 1

Clinical Features

Answer 1

MASS EFFECT
Headache
Visual field defects (Bitemporal Hemianopia)
Cranial nerve palsy (III, IV, VI)

Erosion through sella floor leading to CSF rhinnorrhoea

Question 2

Investigations

Answer 2

MRI: infra and supra-sellar extension

Assess Visual Fields

Basal hormones

Short synacthen and Glucose Tolerance test (if acromegaly suspected)

Water deprivation test if diabetes insipidus suspected

Dexamethasone suppression test if cushing’s

Question 3

Management

Answer 3

Replace hormones : give steroids before levothyroxine as thyroxine can precipitate adrenal crisis

Prolactinoma: first line is dopamine agonist

Surgery:
- Trans-sphenoidal pituitary surgery (trans-frontal if supra-sellar)

Radiotherapy

Question 4

Pituitary Apoplexy

What is it?

Clinical Features

Management

Answer 4

Rapid pituitary enlargement due to bleed into a tumour

Clinical feautres: Acute

• Mass effect: Headache, ophthalmoplegia
• Cardiovascular collapse
• Death

Management:

• Urgent steroids (100mg Hydrocortisone IV)
• Fluid balance
• Surgery