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Hyperpituitarism, Pituitary Adenoma - Coggle Diagram
Hyperpituitarism
Causes
Pituitary Adenoma (MOST Common)
Pituitary Hyperplasia
Hypothalamic Disorders
Extrapituitary Tumours (Ectopic Hormone Production)
Pituitary Carcinoma (VERY RARE)
Investigation
Suppressive Test (for Hormone Excess)
OGTT - Suspect GH Excess
Dexamethasone Suppression Test - Suspect Adrenal Hyperfunction
Imaging Studies (MRI)
Secretion of Inappropriately High Levels of ADH (SIADH)
Causes
Malignant Neoplams (SCLC)
Drugs (Carbamazepine, Morphine)
Infections (Pneumonia, TB, Meningitis, Encephalitis)
Stroke
Features
Clinical
Euvolaemia (No Peripheral Oedema)
Small Volume of Concentrated Urine
Cerebral Oedema
Severe Hyponatremia
Biochemical
Hyponatremia
Decreased Serum Osmolality
Increased Urine Osmolality
Normal Renal, Thyroid & Adrenal Functions
Excessive Secretion of Pituitary Hormones
Pituitary Adenoma
Classification
Prolactinoma/Lactotroph Adenoma
MOST COMMON
Causes
Physiologic
Pregnancy
Nipple Stimulation
Drugs
Dopamine Receptor Antagonist (Haloperidol, Phenothiazines)
Renal Failure
Hypothyroidism
Stalk Effect
Clinical Features
Galactorrhea
Amenorrhea
Loss of Libido
Infertility
Diagnosis
Growth Hormone/Somatotroph Adenoma
2nd MOST Common
Clinical Features
Somatic Effects
Gigantism (Children)
Acromegaly (Adult)
Metabolic Effects
T2DM/Glucose Tolerance
Hypercalcemia
Hyperphosphataemia
Local Mass Effects
Headache
Bitemporal Hemianopia
Hypopituitarism
Diabetes Insipidus
Investigation
Screening Test - IGF-1 Level (Elevated)
PRL, ACTH, TSH (Normal/Low)
Dynamic Function/Suppression Test - OGTT
Imaging - MRI
Mammosomatotroph Adenoma
Corticotroph Adenoma
Gonadotroph Adenoma
Thyrotroph Adenoma
Genetic Abnormalities
G-Protein Mutation (MOST Common)
GNAS Mutations
Inherited Predisposition
MEN1, CDKN1B, PRKAR1A, AIP
Molecular Abnormalities A/w Aggessive Behaviour
Overexpression of Cyclin D1
Mutations of TP53
Epigenetic Silencing of RB Gene
Mutation of RAS Oncogene
Risk Factor
Adults
Morphology
Gross
Massive Tumour
Well-Circumscribed
Monomorphism
Absence of Reticulin Network
Most - Sporadic