Pituitary tumours

• Symptoms may be caused by hypopituitarism, local pressure or hormone secretion
• FSH secreting tumours can cause macro-orchidism in men

Features of local pressure

• Headache
• Visual field defect – bilateral temporal hemianopia
• Palsy of CM III, IV and VI (pressure or invasion of the cavernous sinus)
• Diabetes insipidus
• Disturbance of the hypothalamic centres of temp, sleep and appetite
• Erosion through the floor of the sella leading the CSF rhinorrhoea

Investigations

• Pituitary MRI
• Screening tests – PRL, IGF-1, ACTH, cortisol, TFTs, LH/FSH, testosterone, short synacthen test
• Glucose tolerance test if acromegaly is suspected
• Water deprivation test if diabetes insipidus

Treatment

• Start hormone replacement as required (ensure steroids are given before thyroxine as thyroxine can precipitate and adrenal crisis)
• Surgery
• Mostly trans-sphenoidal but if there is supra-sellar extension the trans-frontal approach may be required
• For prolactinomas first line treatment is medical with a dopamine agonist
• Pre-op ensure hydrocortisone
• Radiotherapy
• Post op is complete removal has not been possible
• Post operatively
• Life long follow up is required as recurrence may occur

Pituitary apoplexy

• Rapid pituitary enlargement due to haemorrhage into the tumour may cause sudden mass effects, cardiovascular collapse due to acute hypopituitarism and death
• Suspect if there is acute onset of headache, meningism, reduced GSC, opthalmoplegia and visual defects
• Treat with urgent steroids and surgery

Craniopharyngioma

• Not strictly a pituitary tumour, it originates from Rathke’s pouch so is situated between the pituitary and the 3^rd ventricle floor
• Rare but is the commonest childhood intracranial tumour
• Adults present with amenorrhoea, reduced libido, hypothalamic symptoms and tumour mass effect
• Tests
  • CT/MRO
• Treatment
  • Surgery plus post-op radiation, test the pituitary function post op