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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 References
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