Pituitary Tumours

Question 1

Possible tumour

Answer 1

Non functioning adenoma
Functioning adenoma
Carcinoma

Question 2

General presentation of pituitary tumours

Answer 2

Headache
Bitemporal hemianopia
Hormone imbalance
Apoplexy => ICP symptoms, SAH mimic

Question 3

Prolactinoma
-presentation

Answer 3

Most common
Female - galactorrhea, amenorrhea
Males - impotence, libido loss, infertility

Question 4

GH secreting pituitary adenoma presentation

Answer 4

Gigantism before puberty
Acromegaly in adults

Skeletal and soft tissue overgrowth
-coarse facial features
-spade hands
-increased shoe size
-big tongue, increased interdental space
-increased sweat, oily skin

HTN
DM
Cardiomyopathy
Colorectal cancer

Question 5

Cushing’s disease presentation

Answer 5

ACTH overproduction => hyperpigmentation

High cortisol
-central weight gain
-osteoporosis, depression, thin skin
-proximal muscle wasting
-hirsuitism, acne
-immunosuppression

High aldosterone => HTN

High androgens => amenorrhea, impotence, low libido

Question 6

Increased TSH, LH, FSH presentation

Answer 6

TSH => hyperthyroidism
LH, FSH => can be asymptomatic

Question 7

Presentation of hypotituitarism (non functioning adenoma)

Answer 7

Low ACTH => low cortisol, aldosterone
-fatigue, low BP

Low GH => growth delay, fatigue

Low LH, FSH => amenorrhea, libido loss, infertility

TSH => cold, myxodema, entrapment, neuropathy, dry skin, brittle nails

Question 8

Management
-medical
-surgical
-interventional

Answer 8

Mass effect, visual changes => urgent endoscopic transphenoidal removal

Hormonal imbalance
-PRL => dopamine agonist (cabergoline, bromocriptine)
-acromegaly => dopamine agonist, somatostatin analogue (octreotide), GH analogue (pegvisomant)
-Cushings => adrenal steroid synthesis antagonist (ketoconazole, metyrapone)

Elective surgery
Radiotherapy, radiosurgery

Question 9

Presentation of pituitary apoplexy
Management

Answer 9

SAH mimic
-thunderclap headache
-N+V
-meningitis

Bitemporal hemianopia/visual changes
3rd 6th nerve palsy

Initial - cortisol => reduce swelling and 2ndary adrenal insufficiency
Definitive if mass effect - surgical removal of pituitary
If no mass effect, manage with hormone replacement and consider surgery

Question 10

Addisonian crisis
-presentation
-management

Answer 10

Cortisol too low => hypoglycaemia
Increased fluid loss from kidney => electrolyte imbalance, hypovolemia, low BP
Leads to shock, coma, death

Hydrocortisone + saline