Pituitary Tumours Flashcards
What percentage does pituitary tumours represent in intracranial neoplasms
- represents 10-25% of all intracranial neoplasms
what are the most characteristic presenting features of pituitary adenomas
- pituitary hormone secretion
- visual field deficits
What are the signs and symptoms of prolactin producing pituitary hormones
- Headache.
- Visual field deficits.
- Oligomenorrhea or amenorrhea.
- Reduced fertility.
- Loss of libido.
- Erectile dysfunction.
- Galactorrhea in the estrogen-primed female breast.
What are the signs and symptoms of adrenocorticotrophic hormone producing pituitary tumours
- Headache
- visual field deficits
- proximal myopathy
- centripetal fat distrubution
- neuropsychiatric symptoms
- striae
- easy bruising
- skin thinning
- hirsutism
- osteopenia
What is the signs and symptoms of growth hormone producing pituitary tumours
- 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
What are the signs and symptoms of thyrotropin-producing pituitary tumours
- palpitations
- tremor
- weight loss
- insomnia
- hyperdefecation
- sweating
what are the signs and symptoms of nonfunctioning adenomas
- 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
What can pituitary apoplexy result from
- acute haemorrhagic or ischemic infarction of the pituitary
What are the signs and symptoms of pituitary apoplexy
- headache
- vomiting
- visual field defects
- ocular paresis
- mental deterioration
- hyponatremia
- syncope
What cancer syndromes can occur as a component of three familial cancer syndromes
- multiple endocrine neoplasia 1
- Carney complex
- isolated familial acromegaly
What are the two different sizes of adenomas
- Microadenomas = less than 10mm
- Macroadenomas = greater than 10mm
most pituitary tumours are…
Microadenomas
What do you use to diagnose a pituitary tumour
MRI
What is the treatment for patients with pituitary tumours
- Surgery.
- Radiation therapy.
- Medical therapy.
- A combination of surgery, radiation therapy, and medical therapy.
What surgical approach is used for pituitary tumours
- Transsphenoidal microsurgical approach
What is the treatment for prolactin producing pituitary tumours
- Dopamine agonists such as cabergoline and bromocriptine
- surgery
- radiation therapy
What is the treatment for adrenocorticotropic hormone producing pituitary tumours
- surgery - usually a transsphenoidal approach
- surgery plus radiation therapy
- radiation therapy
- steroidogenesis inhibitors
What is the treatment options for growth hormone producing pituitary tumours
- Surgery
- dopamine analogs such as bromocriptine
- somatostatin analogs such as octreotide
- the GH receptor antagonists pegvisomant
- surgery and post operative radiation therapy
What is the standard treatment options for thyrotropin producing tumours
- Surgery, with or wihtout adjuvant radiation therapy
- somatostatin analogs such as octreotide
what is the treatment options for nonfunctioning pituitary tumours
- surgery followed by close observation
- radiation therapy
- surgery and postoperative radiation therapy
What is a pituitary adenoma
Pituitary adenomas are benign tumours arising from hormone expressing cells in the anterior pituitary gland
How do functional adenomas present in
- these are more common and present in earlier and younger patients with symptoms and signs of hormone excess
How do non functioning adenomas present
- these are clinically silent until the lesion has become large enough to have a mass effect
what visual field effect does a pituitary adenoma cause
- Bitemporal hemianopia due to chiasmatic compression
how is Hypopituitarism caused by pituitary macroadenoma
- Pituitary macroadenoma can be associated with hormone hyposecretion due to progressive compression of the normal pituitary gland cells
what is the most common pituitary adenoma
- Prolactinomas
Why do pituitary adenomas tend to be missed
- Missed initially due to non-specific symptoms such as tiredness, weight gain, problems with periods, libido and erectile dysfunction
What should you do in a physical examination to distinguish between a functioning pituitary adenoma or hypopituitarism
- 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
What investigations do you carry out
- pituitary screen blood tests to patients with symptoms of hypopituitarism including FSH, LH, 9am cortisol, TSH, oestrogen, 9am testosterone, free T4
If a patient has sudden onset headache and visual symptoms what should you do
refer to the emergency department
- refer to MRI if blood results show coexisting pituitary dysfunction with neurological symptoms
How is pituitary apoplexy treated
- treated with urgent replacement of acute hormone deficiencies and trans-sphenoidal decompression as indicated
