Pituitary tumours

Question 1

Pituitary tumours:

Types?

Answer 1

Typically benign adenomas

≤1cm = microadenoma
≥1cm = macroadenoma

Most common endocrine issues

• Hyperprolactinoma
• Cushings syndrome (cortisol excess)
• Acromegaly (Growth hormone excess)

Or deficiency of other pituitary hormones secondary to other cells type damage

Question 2

Pituitary tumours:

Investigations?

Answer 2

typically MRI brain

hormone biochemistry as relevant to symptom type

Question 3

Pituitary tumours:

Prolactinomas?

Answer 3

Most common pituitary tumour

1) Dopamine agonists
- shrinks tumour within 2 weeks
- will reduce visual field defect

Cabergoline

• dose 1 -2 times oral per week
• best tolerated
• echocardiography in those with parkinsons disease as it increases valve regurgitation

Bromocriptine

• BD or TDS dosing
• safe in pregnancy
• adverse effects: nausea, vomiting, dizziness postural hypotension

Quinagolide
-daily dose

2) Surgery/medical irradiation

Monitoring
-prolactin levels monthly for 3 months then 3 and 6 months and then annually when noralised

IF normal prolactin at ≥2 years AND
tumour has reduced by ≥50%
-Then attempt drug weaning to lowest dose

*during pregnancy macro-prolactinoma may grow with the increased oestrogen

Question 4

Pituitary tumours:

Acromegaly Management?

Answer 4

1) Transphenoid surgery to remove tumour
- 80% cure rate if microadenoma
- 50% if macroadenoma

2) Somatostatin anolagues
- 60% success rate
- suppressed growth hormone production
- reduces tumour size

Ocreotide - monthly IM

Lancreotide - 4 - 8 weekly IM/Subcut

May require addition of dopamine agonists

Overseas Growth Hormone antagonists are available (pegvisomant