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Year 3 - Preparation for Clinical Practise > Pituitary Tumours > Flashcards

Pituitary Tumours Flashcards

1
Q

What percentage does pituitary tumours represent in intracranial neoplasms

A
  • represents 10-25% of all intracranial neoplasms
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2
Q

what are the most characteristic presenting features of pituitary adenomas

A
  • pituitary hormone secretion

- visual field deficits

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3
Q

What are the signs and symptoms of prolactin producing pituitary hormones

A
  • Headache.
  • Visual field deficits.
  • Oligomenorrhea or amenorrhea.
  • Reduced fertility.
  • Loss of libido.
  • Erectile dysfunction.
  • Galactorrhea in the estrogen-primed female breast.
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4
Q

What are the signs and symptoms of adrenocorticotrophic hormone producing pituitary tumours

A
  • Headache
  • visual field deficits
  • proximal myopathy
  • centripetal fat distrubution
  • neuropsychiatric symptoms
  • striae
  • easy bruising
  • skin thinning
  • hirsutism
  • osteopenia
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5
Q

What is the signs and symptoms of growth hormone producing pituitary tumours

A
  • Headache.
  • Visual field deficits.
  • Growth of hands and feet.
  • Coarsening of facial features.
  • Carpal tunnel syndrome.
  • Snoring and obstructive sleep apnea.
  • Jaw growth and prognathism.
  • Osteoarthritis and arthralgia
  • excessive sweating
  • dysmorphophobia
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6
Q

What are the signs and symptoms of thyrotropin-producing pituitary tumours

A
  • palpitations
  • tremor
  • weight loss
  • insomnia
  • hyperdefecation
  • sweating
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7
Q

what are the signs and symptoms of nonfunctioning adenomas

A
  • headache
  • visual field deficits
  • pituitary insufficiency which is due to the compression of the pituitary stalk or destruction of normal pituitary tissue by the tumour
  • rarely ovarian overstimulatoin, testicular enlargement, increased testosterone levels
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8
Q

What can pituitary apoplexy result from

A
  • acute haemorrhagic or ischemic infarction of the pituitary
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9
Q

What are the signs and symptoms of pituitary apoplexy

A
  • headache
  • vomiting
  • visual field defects
  • ocular paresis
  • mental deterioration
  • hyponatremia
  • syncope
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10
Q

What cancer syndromes can occur as a component of three familial cancer syndromes

A
  • multiple endocrine neoplasia 1
  • Carney complex
  • isolated familial acromegaly
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11
Q

What are the two different sizes of adenomas

A
  • Microadenomas = less than 10mm

- Macroadenomas = greater than 10mm

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12
Q

most pituitary tumours are…

A

Microadenomas

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13
Q

What do you use to diagnose a pituitary tumour

A

MRI

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14
Q

What is the treatment for patients with pituitary tumours

A
  • Surgery.
  • Radiation therapy.
  • Medical therapy.
  • A combination of surgery, radiation therapy, and medical therapy.
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15
Q

What surgical approach is used for pituitary tumours

A
  • Transsphenoidal microsurgical approach
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16
Q

What is the treatment for prolactin producing pituitary tumours

A
  • Dopamine agonists such as cabergoline and bromocriptine
  • surgery
  • radiation therapy
17
Q

What is the treatment for adrenocorticotropic hormone producing pituitary tumours

A
  • surgery - usually a transsphenoidal approach
  • surgery plus radiation therapy
  • radiation therapy
  • steroidogenesis inhibitors
18
Q

What is the treatment options for growth hormone producing pituitary tumours

A
  • Surgery
  • dopamine analogs such as bromocriptine
  • somatostatin analogs such as octreotide
  • the GH receptor antagonists pegvisomant
  • surgery and post operative radiation therapy
19
Q

What is the standard treatment options for thyrotropin producing tumours

A
  • Surgery, with or wihtout adjuvant radiation therapy

- somatostatin analogs such as octreotide

20
Q

what is the treatment options for nonfunctioning pituitary tumours

A
  • surgery followed by close observation
  • radiation therapy
  • surgery and postoperative radiation therapy
21
Q

What is a pituitary adenoma

A

Pituitary adenomas are benign tumours arising from hormone expressing cells in the anterior pituitary gland

22
Q

How do functional adenomas present in

A
  • these are more common and present in earlier and younger patients with symptoms and signs of hormone excess
23
Q

How do non functioning adenomas present

A
  • these are clinically silent until the lesion has become large enough to have a mass effect
24
Q

what visual field effect does a pituitary adenoma cause

A
  • Bitemporal hemianopia due to chiasmatic compression
25
Q

how is Hypopituitarism caused by pituitary macroadenoma

A
  • Pituitary macroadenoma can be associated with hormone hyposecretion due to progressive compression of the normal pituitary gland cells
26
Q

what is the most common pituitary adenoma

A
  • Prolactinomas
27
Q

Why do pituitary adenomas tend to be missed

A
  • Missed initially due to non-specific symptoms such as tiredness, weight gain, problems with periods, libido and erectile dysfunction
28
Q

What should you do in a physical examination to distinguish between a functioning pituitary adenoma or hypopituitarism

A
  • offer all patients with a headache a visual field to confrontation test - simple screening examination to help identify large pituitary macroadenomas
  • in suspected Cushings and acromegaly it can be useful to ask patients for old photographs of themselves to help identify change
29
Q

What investigations do you carry out

A
  • pituitary screen blood tests to patients with symptoms of hypopituitarism including FSH, LH, 9am cortisol, TSH, oestrogen, 9am testosterone, free T4
30
Q

If a patient has sudden onset headache and visual symptoms what should you do

A

refer to the emergency department

- refer to MRI if blood results show coexisting pituitary dysfunction with neurological symptoms

31
Q

How is pituitary apoplexy treated

A
  • treated with urgent replacement of acute hormone deficiencies and trans-sphenoidal decompression as indicated

Year 3 - Preparation for Clinical Practise (33 decks)

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