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Pituitary tumours (Diagnosis (History (PC/HPC Endocrine symptoms, visual…
Pituitary tumours
Diagnosis
Examination
General exam
External signs of endocrine disease
(hyperprolactinaemia, Cushings, Acromegaly)
CN exam
Reduced acuity, reduced fields (bitemporal hemianopia),
CN palsies (III, IV, VI)
Investigations
Bloods
FBC (anaemia), U+E, LFT, TFT, glucose (hyperglycaemia),
lipids (hyperlipidemia)
Hormones (FSH/LH and oestrogen/testosterone, GH/GLP-1, TSH and TH, ACTH and cortisol, PRL, ADH)
Imaging
MRI head (pituitary tumour)
Bedside
Obs (may have HTN)
ECG (arrhythmias, LVH)
Weight (gain/loss)
Special tests
OGTT (acromegaly)
Short synacthen test (hypoadrenalism)
Water deprivation test (ADH)
History
PC/HPC
Endocrine symptoms, visual disturbance,
headaches
PMH
Previous cancers, endocrine disorders
Previous surgery, head injury
DH
Meds, allergies
FH
CNS tumours, other cancers
SH
Living arrangements, occupation,
smoking, alcohol, diet
Management
Medical
DA agonists
Indication: 1L prolactinoma
E.g. bromocriptine, carbergoline
MOA: DA agonist, inhibit PRL release
Hormone replacement
Indication: hyposecretion
E.g. thyroxine, hydrocortisone, oestrogen, testosterone, ILGF-1
NB: give hydrocortisone before thyroxine
(can precipitate an adrenal crisis)
RT
Indication: residual/recurrent disease
Surgical
Transphenoidal/transfrontal surgery
Indication: most tumours
MOA: removal of tumour via nose
Conservative
Information, advice, support
Identify type of tumour
Lifelong FU (hormones, imaging)
Epidemiology
Uncommon
10% CNS tumours
Pathophysiology
Classification
Size
Macroadenoma
Microadenoma
Histology
Chromophobe (commonest): non-functioning, often mass effects
Acidophile: Secrete PRL, GH
Basophile: Secrete ACTH
Activity
Mixed
Hypersecretion of some hormones and hyposecretion of others
Hypersecretion
Usually pituitary tumour secreting excess hormone
Rarely, hypothalamic or ectopic tumours
PRL (commonest), GH, ACTH, others rare
Hyposecretion
Some tumours may loose function and stop
secreting hormone i.e non-functioning
Commonest type
Clinical
presentation
Hormone effects
Symptoms of hypo/hyper
Local pressure effects
Headache
Reduced visual acuity
Reduced visual fields
Cranial nerve palsy
Diplopia
Rhinorrhoea
Complications
Recurrence
Subfertility
(Gonadotrophins affected)
Definition
Neoplasm of the
pituitary gland