Endocrine

Pituitary Tumours

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Pathology

Monoclonal tumours with tumour activity depending on cell type
Corticotrophs-Cushing’s Disease 
Comatotrophs- Increased Growth hormone secretion
Thyrotrophs- Increased TSH Secretion
Gonadotrophs- Increased FSH/LH secretion.

Aetiology

Mutations in oncogenes: Gsα (~40% of GH-secreting tumours) and 
Ras (aggressive tumours)
Multiple Endocrine Neoplasia: Type 1

Signs

Bi-temporal hemianopia, CSF rhinorrhoea, signs of raised ICP, cranial nerve palsy of nerves III, IV and VI within the cavernous sinus.

Symptoms

Headache (typically worse on waking), fatigue, myalgia, double vision, nasal congestion

Investigations

Bloods: Pituitary profile. Likely to need Dynamic Endocrine Testing. 
Special tests: Humphrey’s field test
Imaging: MRI pituitary

Treatment

Medical: Hormone replacement as required and radiotherapy is surgery not 
possible
Surgical: Trans-sphenoidal surgery 

Prognosis

Good where tumour fully resected and no hormone pathology.
Apoplexy (bleed into pre-existing tumour), hypopituitarism

Key Facts

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Key Images

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Key References

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