Surgical management of Pituitary tumors

Question 1

Pituitary gland tumors most commonly affects what decade of life

Answer 1

3rd-4th

Question 2

What are the 3Ps of MEN I

Answer 2

Pituitary
Parathyroid
Pancreas

Question 3

T or F Most pituitary tumors arise from the anterior pituitary

Answer 3

True

Question 4

Most common presentations are due to

Answer 4

Endocrine and mass effect

Question 5

Classification that is being used by endocrinologists

Answer 5

Functional

Question 6

In this classification the pituitary gland doesn’t secrete hormones, it just causes mass effect

Answer 6

Non functional

Question 7

Difference btn micro and macroadenoma

Answer 7

Microadenoma is less than 1cm, macro >1cm

Question 8

Presentation of prolactin hypersecretion

Answer 8

Amenorrhea/galactorrhea

Question 9

Presentation of GH hypersecretion

Answer 9

Gigantism/acromegaly

Question 10

Presenation of Corticotropin hypersecretion

Answer 10

Cushing dse

Question 11

What could be the manifestation if there’s optic chaism impingement?

Answer 11

Bitemporal bilateral hemianopsia

Question 12

Most common manifestation of mass effect

Answer 12

Blurring of vision (gradual loss of vision)

Question 13

What are the most vulnerable in terms of mass effect

Answer 13

Gonadotrophs

Least vulnerable: somatotrophs, corticotrophs

Question 14

If the tumor compresses the 3rd ventricle what could be the presentation

Answer 14

Hydrocephalus

Question 15

Carcinomas that has eroded the floor of the sella

Answer 15

Invasive adenomas

Question 16

Neurologic and/or endocrinologic deterioration due to sudden expansion of a mass within the sella turcica

Answer 16

Pituitary apoplexy

Question 17

Clinical features of pituitary apoplexy

Answer 17

Visual disturbance
Reduced Mental status
Cavernus sinus compression
Subarachnoid Hemorrhage
Acute Hydrocephalus

Question 18

Typical presentation of pituitary apoplexy

Answer 18

Paroxysmal HA w/ endocrinological and/or neurological deficit (visual loss or ophthalmoplegia)

Question 19

Management of Pituitary apoplexy

Answer 19

Immediate administration of glucocorticoids and decompression

Question 20

T or F active sinus infection is a surgical contraindication

Answer 20

True

Question 21

Most common type of secretory pituitary tumor

Answer 21

Prolactin secreting adenoma

Question 22

T or F prolactin secreting adenoma is more common in women than in men

Answer 22

True

Question 23

What are the presumed defects in prolactin secreting adenomas

Answer 23

Abnormalities in secretion of GHRH and gonadotropin precipitate relative estrogen deficiency

Question 24

Reduction of what enzyme activity occurs in prolactin secreting adenomas in men

Answer 24

5-a reductase, this converts testosterone to dihydrotestosterone

Question 25

dopamine agonist that suppresses prolactin production and release by direct stimulation of neuronal and pituitary cell membrane dopamine receptors

Answer 25

Bromocriptine

Question 26

What should you monitor after giving bromocriptine?

Answer 26

Serum prolactin levels

Question 27

Initial treatment of choice for patients with acromegaly

Answer 27

Surgical resection

Question 28

Level of GH to reach the cure rate

Answer 28

Less than 1ng/ml during an OGTT and normalization of age adjusted plasma IGF-1

Question 29

Refers to any pathologic or iatrogenic state of glucocorticoid excess

Answer 29

Cushing’s syndrome

Question 30

Refers specifically to hypercortisolimic states generated in response to an ACTH secreting pituitary tumor

Answer 30

Cushing’s disease

Question 31

First line of treatment

Answer 31

Pharmacotherapy

Question 32

only pituitary tumor for which medical therapy has a proven and primary role

Answer 32

Prolactinoma

Question 33

How long should you give bromocriptine

Answer 33

Forever: this is a lifetime therapy, once you discontinue the tumor will grow back