Pituitary Gland Disease

  1. Selective of panhypopituitary (total) failure
  2. Can present as visual failure, selective excess of specific hormones (due to tumour hyper-secretion), and hyperprolcatinaemia (from mass lesions).
  3. Diseases include:
    1. o Intrinsic neoplastic processes: as above
    2. o Inflammatory processes: TB, sarcoidosis, invasion by extrinsic tumour cells (=pit failure or hyperprolactinaemia due to disruption of tonic dopamine-mediated inhibition to PRL release).
    3. o Pituitary apolplexy (‘haemorrhage leading to ischaemia’): infarction
    4. o Pituitary atrophy: infarction due to hypotension (post-partum = ‘Sheehan’s syndrome’). Pit failure can occur immediately or up to 2 years post-hypotensive episode.
    5. o Pituitary tumours:
    6. Account for 10% of intracranial neoplasms
    7. Classified according to size:
    8. Microadenomas: <1cm in diameter. No mass effect or hypopituitarism.
    9. Macroadenomas: >1cm. Can produce mass effect and hypopituitarism. Usually non-functioning but can cause excessive hormone secretion.
    10. The features of pit tumours can be predicted based on which hormones have been lost/gained
  4. Ix:
    1. o Pituitary function: hormones and their targets are measured, GH, IGF-1, FSH, LH, testosterone/oestradiol, ACTH, TSH, PRL, ADH…
    2. o Underlying disease process: assess with MRI and biopsy
    3. o Mass effects: visual field loss (compressed optic chiasma = bitemporal hemianopia), headache (during stretching – due to stretching of dura), CN palsies (on lateral extension), or CSF rhinorrhoea/secondary meningitis (due to downward erosion into sphenoid sinus).
    4.  
  1. Mx:
    1. o Replace anterior hormones, hydrocortisone and thyroxine to replace ACTH and TSH deficiency, sex hormne and GH therapy.
    2. o Tx underlying causes: if non-functioning tumour – remove surgically (=trans-sphenoidally or craniotomy)and may need post-op RT. Functioning tumours are tx with RT, drugs and surgery 
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