Pituitary tumours and other Sellar disorders Flashcards by Sasha Murdoch

How are pituitary adenomas classified

According to their size:
macroadenomas 1+ cm
Microadenomas

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What are functioning pituitary tumours associated with

excess anterior pituitary hormone secretion

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When is the peak age to develop a pituitary tumour

around 30-60 years

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Males usually present earlier than females. true or false

false - women usually present before males

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What are the most common pituitary macro adenomas

Non-functioning pituitary adenomas

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What is responsible for tumours that occur in MEN1

Loss of function mutations of MEN 1

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What are some of the presenting complaints of patients with a pituitary tumour

Hyper secretion of pituitary hormone
hypopituitarism
headache
compression of the surrounding structures such as the optic chiasm

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How might a prolactin-secreting adenoma present

galactorrhoea
amenorrhoea
infertility
impotence

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What do ACTH secreting adenomas cause

Cushing’s disease

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What do GH secreting adenomas cause

acromegaly

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How do TSH secreting adenomas present

secondary hyperthyroidism with or without a goitre

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What might a pituitary tumour in the anterior pituitary result in

A decreased secretion of anterior pituitary hormones due to compression or destruction of the surrounding normal pituitary cells

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How might a GH deficiency present

Fatigue 
impaired psychological well-being 
reduced energy 
muscle strength and exercise capacity 
increased abdominal adiposity

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How might an LH and FSH deficiency present in males

Reduced libido 
impotence
infertility 
loss of body hir 
fine premolar wrinkles 
flushes

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How might an LH and FSH deficiency present in females

Oligomenorrhoea 
amenorrhoea
infertility 
dyspareunia 
breast atrophy 
flushes

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How might a TSH deficiency present

Fatigue 
apathy 
muscle weakness
cold intolerance 
constipation 
weight gain 
dry skin

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How might an ACTH deficiency present

fatigue 
weakness
nausea
vomiting
weight loss 
hypoglycaemia 
loss of pubic and axillary hair in females

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How might a vasopressin (ADH) deficiency present

Polyuria
nocturia
polydipsia

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What causes headaches

stretching or invasion of the dura

Large tumours with suprasellar extension may occasionally cause obstructive hydrocephalus

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What might involve the optic chiasma (bitemporal visual field loss)

suprasellar extension of the tumour

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What can cause hyperprolactinaemia which may cause hypogonadism

stalk compression

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What may cause cranial nerve palsies and diplopia

Lateral extension and cavernous sinus invasion

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What might inferior extension result in

CSF rhinorrhoea due to erosion of the sphenoid sinus

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What are pituitary incidentalomas

Mass lesions (usually adenomas) that are deleted following radiological imaging of the skull or brain for another clinical reason

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What are some investigations for suspected pituitary tumours

Basal and dynamic pituitary function tests pituitary MRI formal visual field assessment

What are 2 lab pitfalls we need to be aware of when measuring prolactin levels

Hook effect - assay uses antibodies that recognise two different sites on the prolactin molecule Very high prolactin levels may be artifactual reported as normal or only modestly elevated Hyperprolactinaemia may be due to decreased clearance of a complex of prolactin with IgG - macroprolactin

In what cases is IGF-1 levels high

In patients with GH secreting pituitary tumours causing acromegaly

Whate are some investigations for ADH deficiency

Measurement of serum and urine osmolality and sodium concentration and the water deprivation test

When is the insulin tolerance test contraindicated | What should be done instead

Patients with a history of epilepsy or ischaemic heart disease Glucagon test

What is the preferred imaging modality for the pituitary gland

MRI

What are the treatment options for patients with pituitary tumours

Surgery - reduce local compression effects, reduce excess hormone secretion

What is the first line surgery for almost every case

Trans-sphenoidal

How should secondary adrenal insufficiency be treated

Hydrocortisone but only after excluding or treating adrenal insufficiency

Why does fluid balance have to be very carefully monitored post operatively

to watch for the possible development of diabetes insipius

How does diabetes insipidus present

poluria

What in the patients urine can be tested as a quick test for diabetes insipidus

Specific Gravity

How is diabetes insipidus diagnosed

If the plasma osmolality is high or plasma sodium is over 145mmolL in the presence of an inappropriately low urine osmolality/ SG

What drug can be given if sodium is too high and they are not managing to drink enough

desmopressin

What must be checked 7-10 days post op and why

Serum sodium as there is a risk of hyponatraemia

How is cerebral salt wasting treeated

saline administration

how is the syndrome of inappropriate ADH (SIADH) treated

fluid restriction

What are the indications of radiotherapy following a pituitary surgery

shrink residual or recurrent tumour | reduce the likelihood of regrowth treat persistent hormone hyper secretion

What are some short term complications of radiotherapy on the pituitary

hair loss headache nausea

What are some long term complications of radiotherapy on the pituitary

Hypopituitarism | Visual impairment

What is included in the follow up from pituitary surgery

Visual acuity and fields | Pituitary function testing including serum cortisol 0am

When should a pituitary MRI be repeated

4 months after the surgery - so that the immediate inflammatory post op changes do not influence the results

What is pituitary apoplexy

Acute hemorrhagic infarction of a pituitary tumour resulting in gland destruction and compression of surrounding structures by the oedematous enlarged pituitary tumour

How does pituitary apoplexy present

``` acute headache meningism visual impairment ophthalmoplegia sometimes altered consciousness ```

What are some investigations for pituitary apoplexy

PItuitary MRI and pituitary function tests

What is the treatment for pituitary apoplexy

Life saving IV Hydrocortisone replacement | Surgery within 8 days although not for those with no significant problems

What is Sheehan's syndrome

Pituitary gland necrosis caused by hypertension due to postpartum haemorrhage

How might patients with Sheehan's syndrome present

After delivery failure of lactation failure to resume menses fatigue, weight loss, anorexia

What is empty sella syndrome characterised by

an enlarged sella filled with CSF

What might primary empty sella syndrome be due to

a defective and enlarged diaphragma sella opening

What might cause empty sella syndrome

A developmental anomaly increased intracranial pressure compression and posterior displacement of the anterior pituitary

Who is empty sella syndrome more common in

middle aged women

What might secondary empty sella syndrome be due to

infarction surgery radiotherapy of a pituitary adenoma

What are craniopharyngiomas

benign tumours that arise from squamous epithelial remnants of Rathke\s pouch

What do craniopharyngiomas commonly cause

diabetes insipidus

What are the major presenting symptoms of craniopharyngiomas

Growth retardation in children and visual abnormalities in adults

What are meningiomas

Usually benign tumours arising from the meninges

What are germ cell tumours usually associated with

simultaneous lesions in the pineal gland

What might abscess in the pituitary result form

local spread - e.g. from sphenoid sinusitis | or may be secondary to septicaemia

What is lymphocytic hypophysitis characterised by

lmphocytic infiltration of the anterior pituitary followed by fibrosis

Who does lymphocytic hypophysitis affect

women most commonly during pregnancy or the postpartum period

What is sarcoidosis

An inflammatory granulomatous multisystem disorder that may affec multiple organs such as the eyes, skin, lungs, joints and CNS

What is hereditary haemochromatosis

An inherited disorder characterised by increased intestinal iron absorption and iron deposition in various grans due to mutations in the HFE gene

Traumatic brain injury may result in what

hypopituitarism

What are the 3 main complications of pituitary surgery

Cerebral infection diabetes insipidus hypopituitarism

Pituitary tumours and other Sellar disorders Flashcards

(69 cards)