Pituitary Disorders

Question 0

Neurologic presentation of sellar mass

Answer 0

Bitemporal hemianopsia (from pressure on optic chiasm)

-visual impairment, HA, diplopia, CSF rhinorrhea (yikes)

Question 1

Most common sellar mass

Answer 1

Pituitary adenoma

Rare to have pituitary carcinoma, usually mets from lungs or boobies

Question 2

Impaired secretion of LH/FSH -> low testosterone, amenorrhea
Excessive prolactin -> galactorrhea
Excessive ACTH -> Cushing’s
Excessive TSH -> Hyperthyroid

Answer 2

Hormonal changes that are common presentation of sellar mass

more likely to find it this way than with neurologic sx or random MRI

Question 3

Adenomas are masses that secrete hormones
Several kinds of pituitary adenomas

*Microadenoma 1cm

Answer 3

(check - to detect) 
serum prolactin - Lactotroph  
serum IGF-1, GH - Somatroph 
serum TSH - Thyrotropin 
24 hour urine cortisol, serum ACTH, serum cortisol- Cortiotroph

Question 4

Single best imaging study for pituitary mass

Answer 4

MRI w/ and w/o gadolinium

Question 5

HYPOSECRETION of FSH, LH, testosterone, vasopressin, etc

Answer 5

Caused by hypothalmic or other pituitary lesion.

NOT an adenoma (which is a secretion mass)

Question 6

Visual disturbances, HA, thryoid dysfxn
Men- low libido, impotence, infertile, man boobs, galactorrhea
Women - infertile, oligo/amenorrhea, galactorrhea

Answer 6

Signs and sx of Prolactinoma
(lactotroph adenoma)

-In post-menopausal visual impaire and HA are only signs

Question 7

If suspect Prolactinoma, things to check before MRI

Answer 7

Med use
Pregnant
Renal disease

Question 8

Levels of serum prolactin

Answer 8

>20 = hyperprolactinemia
>200 = adenoma

Question 9

First line tx for medical management of Prolactinoma

surgery is best bet but can medically manage too

Answer 9

Bromocriptine (Parlodel)

Also, cabergoline (dostinex) which has fewer side effects but increased heart disease so not first line

Question 10

Surgical management of Prolactinoma

Answer 10

Transphenoidal resection

-can lead to SIADH

Question 11

Radiotherapy for Prolactinoma

Answer 11

Used only if refractory to medical or surgical

Must be done in conjunction w/ medical mngt

Question 12

Most accurate marker of GH imbalance

Answer 12

IGF-1

Question 13

Most effective tx for rapid reduction of GH

Answer 13

Surgical management

Question 14

Recommended test for further confirmation of GH abnormality

Answer 14

Arginine growth hormone releasing hormone