Pituitary Tumors
- 15% of
all intracranial tumors, 20-40 years old, F>M (except growth hormone
M>F)
- Prolactinoma
> ACTH
> GH > FSH > TSH
- Headache,
Bitemporal hemianopsia, Endocrine abnormalities
- Types:
- Prolactin
secreting
- Females
– amenorrhea and galactorrhea
- Males –
Headache, visual changes and impotence
- Somatotrophic
(growth hormone) secreting
- Young
patients – gigantism
- Adults
– acromegaly
- ACTH
secreting (Cushing’s disease)
- Truncal
obesity, moon fascies, straie, hirsutism, easy bruising, poor wound
healing, glucose intolerance, HTN, osteoporosis, amenorrhea/impotence
- Nelson’s
syndrome – ACTH secreting pituitary tumor with hyperpigmentation
- Seen in
10% of patients s/p bilateral adrenalectomy for Cushing’s syndrome
- TSH
secreting
- Gonadotropin
secreting
- Pituitary
apoplexy – acute massive hemorrhage causing sudden HA, altered LOC, neck
stiffness, impaired vision, and altered extraocular movements
- Radiology: Sellar mass (MRI is
imaging of choice)
- On rapid
sequence contrasted MRI, immediate scan of adenoma will show enhancing
pituitary gland (remember pituitary has no blood-brain barrier) around
non-enhancing tumor
- Later
scan will show enhancing gland and tumor
- Still
later scan will show enhancing tumor alone
- Treatment: Surgical excision
(craniotomy vs. transphenoidal)
- Radiation
therapy (conventional vs. radiosurgery)
- Medical
therapy
- Prolactin
secreting – bromocriptine
- Growth
hormone secreting – bromocriptine
- ACTH
secreting – metyrapone, cyproheptadine, metergoline
- Prognosis: Many long-term survivors
- Nelson’s
disease – pituitary
enlargement after adrenalectomy, associated with Crooke’s hyaline change
(intermediate filaments)
- Lymphocytic
hypophysitis –
peripartum, autoimmune
- Giant
cell granuloma
– noncaseating
- Empty
sella syndrome
– primary (developmental) or secondary (radiation, stroke, Sheehan’s
syndrome)