Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Pituitary Adenoma 
 Abdulaziz R. Alanzi 
 Medical Student, Al-Imam University 
 Riyadh, Saudi Arabia
Overview 
 Pituitary adenoma is primary tumor that occur in the pituitary gland. 
 99% of pituitary gland tumors are ben...
Risk Factors 
Multiple endocrine 
neoplasia (MEN) 
type 1 
Pituitary 
Adenoma 
Parathyroid 
Tumor 
Pancreatic 
Tumor 
Carn...
Clinical Manifestations 
 Mass effect: 
 Headache  Visual Defects: 
Bitemporal hemianopia 
(due to compression of optic...
Clinical Manifestations 
Hormonal deficiencies - Clinical effects 
Growth hormone 
deficiency 
• Adults - Increased rate 
...
Clinical Manifestations 
Hormonal deficiencies - Clinical effects 
Corticotrophin deficiency 
• Initially, symptoms nonspe...
Clinical Manifestations 
Hormonal overproduction - Clinical effects 
Prolactin * 
• Hypogonadism, if 
hyperprolactinemia 
...
Clinical Examination Finding 
Neuro-ophthalmologic examination 
 Visual acuity can be decreased in one or both eyes. 
 P...
Clinical Examination Finding 
Hypopituitarism 
 Chronic hypopituitarism results in hypotension, generalized weakness, 
hy...
Clinical Examination Finding 
Cushing Disease 
Findings are prominent and include obesity, centripetal fat deposition, 
pr...
Clinical Examination Finding 
Acromegaly 
 Large hands and feet (with thick fingers and toes) and coarse facial features ...
Differential Diagnosis 
 Craniopharyngioma 
 Rathke's cleft cyst 
 Meningioma 
 Brainstem Gliomas 
 Glioblastoma Mult...
Diagnosis 
Blood chemistry tests: pituitary hormones level: 
 Prolactinomas: Serum prolactin level 
 Growth hormone abno...
Staging 
Classification for pituitary adenomas based on imaging 
0 Pituitary gland appears normal. 
I Microadenoma enclose...
Management - Hormonal deficiencies
Management - Hormonal overproduction 
Prolactinoma: 
Dopaminergic agonists 
(bromocriptine, 
cabergoline and 
Quinagolide)...
Management - Hormonal overproduction 
Corticotropin-secreting pituitary tumors: 
• surgery and radiation therapy 
# Medica...
Complications 
 Vision loss 
 Pituitary hormone insufficiency, including 
diabetes insipidus, hypothyroidism, and 
hypog...
Summary 
 99% of pituitary gland tumors are benign 
 Accounts for 10-15% of all intracranial tumors. 
 Risk factors inc...
References
Thank You 
AbdulazizROA@gmail.com 
@Azizocyte
Upcoming SlideShare
Loading in …5
×

Pituitary Adenoma

6,300 views

Published on

Author: Abdulaziz R. Alanzi

Published in: Health & Medicine
  • Dating direct: ❶❶❶ http://bit.ly/2Q98JRS ❶❶❶
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Sex in your area is here: ♥♥♥ http://bit.ly/2Q98JRS ♥♥♥
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Would you rather read the text transcript of how a burnt-out, 40 year old mother lost 84lb doing NO exercise, using a simple set of Flavor-Pairing Rituals? Read The Text Version Here To Find Out.. ➤➤ http://t.cn/AiYhcYmI
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • I recovered from bulimia. You can too! learn more... ♥♥♥ http://tinyurl.com/yxcx7mgo
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Pituitary Adenoma

  1. 1. Pituitary Adenoma  Abdulaziz R. Alanzi  Medical Student, Al-Imam University  Riyadh, Saudi Arabia
  2. 2. Overview  Pituitary adenoma is primary tumor that occur in the pituitary gland.  99% of pituitary gland tumors are benign  Most commonly diagnosed in people between the ages of 30 and 50 years  Accounts for 10-15% of all intracranial tumors.  Symptomatic prolactinomas and Cushing disease are found more frequently in women.  Pituitary adenomas are classified by their cell of origin (lactotroph, gonadotroph, somatotroph, corticotroph, and thyrotroph) and their size: microadenoma (diameter < 1cm), macroadenoma (diameter ≥ 1cm)
  3. 3. Risk Factors Multiple endocrine neoplasia (MEN) type 1 Pituitary Adenoma Parathyroid Tumor Pancreatic Tumor Carney complex Pituitary Adenoma Adrenal Tumors Myxomas Familial isolated pituitary adenoma McCune-Albright syndrome Prolactinoma Acromegaly Growth Hormone Secreting Tumor 1 2 3 4
  4. 4. Clinical Manifestations  Mass effect:  Headache  Visual Defects: Bitemporal hemianopia (due to compression of optic chiasm).
  5. 5. Clinical Manifestations Hormonal deficiencies - Clinical effects Growth hormone deficiency • Adults - Increased rate of cardiovascular disease, obesity, reduced muscle strength and exercise capacity, and increased cholesterol • Infants –Hypoglycemia • Children - Decreased height and growth rate Gonadotrophin deficiency • Men - Diminished libido and impotence; testes shrink in size, but spermatogenesis generally preserved • Women - Diminished libido and dyspareunia; breast atrophy in chronic deficiency • Children - Delayed or frank absence of puberty Thyrotropin deficiency •Malaise, • weight gain, • lack of energy, • cold intolerance, • constipation
  6. 6. Clinical Manifestations Hormonal deficiencies - Clinical effects Corticotrophin deficiency • Initially, symptoms nonspecific (eg, weight loss, lack of energy, malaise); severe adrenal insufficiency may present as a medical emergency Panhypopituitarism Refers to deficiency of several anterior pituitary hormones.
  7. 7. Clinical Manifestations Hormonal overproduction - Clinical effects Prolactin * • Hypogonadism, if hyperprolactinemia sustained • Women - Amenorrhea, galactorrhea, and infertility • Men - Decreased libido, impotence, and rarely galactorrhea Growth hormone • Children and adolescents - May result in pituitary gigantism • Adults – Acromegaly Changes in the size of the hand and feet, coarseness of the face, frontal bossing, and prognathism result. Further changes in the voice, and hirsutism, confirm the diagnosis. • Acromegaly frequently results in glucose intolerance, with 20% of patients progressing to diabetes mellitus. • Carpal tunnel syndrome is seen frequently. Cushing disease • Weight gain, central obesity, moon facies, violet striae, easy bruisability.
  8. 8. Clinical Examination Finding Neuro-ophthalmologic examination  Visual acuity can be decreased in one or both eyes.  Pupillary light reaction can be abnormal.  Color vision can be affected.  Larger lesions may be associated with a bitemporal hemianopsia.  Optic atrophy is seen frequently
  9. 9. Clinical Examination Finding Hypopituitarism  Chronic hypopituitarism results in hypotension, generalized weakness, hypothermia, malaise, and depression.  Acute sudden hypopituitarism (ie, pituitary apoplexy) is associated with Prolactinomas shock, coma, and death.  In females, galactorrhea may be present on clinical examination. Women undergoing an infertility evaluation may be found to have a prolactinoma.  In males, galactorrhea is infrequent; testicles may be decreased in size and may be soft to palpation.
  10. 10. Clinical Examination Finding Cushing Disease Findings are prominent and include obesity, centripetal fat deposition, proximal myopathy, moon facies, buffalo hump, posterior subcapsular cataracts, arterial hypertension, bruises, and skin striae.
  11. 11. Clinical Examination Finding Acromegaly  Large hands and feet (with thick fingers and toes) and coarse facial features with frontal bossing. Women may appear masculinized. Other findings might include prognathism, carpal tunnel syndrome, and voice quality changes.
  12. 12. Differential Diagnosis  Craniopharyngioma  Rathke's cleft cyst  Meningioma  Brainstem Gliomas  Glioblastoma Multiforme  Germinoma  Pituitary hyperplasia  Ependymoma  Low-Grade Astrocytoma  Primary CNS Lymphoma
  13. 13. Diagnosis Blood chemistry tests: pituitary hormones level:  Prolactinomas: Serum prolactin level  Growth hormone abnormalities: Growth hormone (GH) levels - insulin-like growth factor-1 (IGF-1) - Oral glucose tolerance test  Cushing disease: 24 hrs urine collection for free cortisol, Dexamethasone suppression test, Serum levels of ACTH.  Thyroid hormones, including thyrotropin (TSH), thyroxine (T4) and triiodothyronine (T3)  Luteinizing hormone (LH) - follicle-stimulating hormone (FSH) - estrogen - estradiol - testosterone Imaging Tests: MRI, CT-Scan
  14. 14. Staging Classification for pituitary adenomas based on imaging 0 Pituitary gland appears normal. I Microadenoma enclosed within the sella turcica. II Macroadenoma enclosed within the sella turcica. III Tumour invades into the sella turcica locally (in one place). IV Tumour invades into the sella turcica diffusely (in more than one place). Grading for suprasellar extension A 0–10 mm suprasellar extension occupying the suprasellar cistern B 10–20 mm extension and elevation of the third ventricle C 20–30 mm extension occupying the anterior (front) of the third ventricle D Larger than 30 mm extension, beyond the foramen of Monro, or grade C with lateral extensions
  15. 15. Management - Hormonal deficiencies
  16. 16. Management - Hormonal overproduction Prolactinoma: Dopaminergic agonists (bromocriptine, cabergoline and Quinagolide) Growth hormone-secreting tumors: Gonadotropin-secreting pituitary tumor: Thyrotropin-secreting tumors • Surgery, often followed by radiation therapy. • Medical treatment (Octreotide) Nonsecretory pituitary adenomas • Surgery • If surgery is contraindicated, medical treatment (Bromocriptine or Octreotide)
  17. 17. Management - Hormonal overproduction Corticotropin-secreting pituitary tumors: • surgery and radiation therapy # Medical therapy: • Central acting agents: (bromocriptine, valproic acid, and cyproheptadine). • Peripheral acting agents: (ketoconazole, mitotane, and metyrapone).
  18. 18. Complications  Vision loss  Pituitary hormone insufficiency, including diabetes insipidus, hypothyroidism, and hypogonadism, may occur.  Pituitary apoplexy: is bleeding into or impaired blood supply of the pituitary gland at the base of the brain.
  19. 19. Summary  99% of pituitary gland tumors are benign  Accounts for 10-15% of all intracranial tumors.  Risk factors include MEN type 1, Carney complex, Familial isolated pituitary adenoma…etc  Clinical manifestation include headache, visual defects, and other symptoms depending on which pituitary hormone involved in the disease.  The diagnosis is confirmed by testing hormone levels, and by radiographic imaging of the pituitary.  Management include surgery, radiation therapy, medical therapy depending of the type of pituitary adenoma.  Complications might include vision loss, pituitary hormone insufficiency, pituitary apoplexy.
  20. 20. References
  21. 21. Thank You AbdulazizROA@gmail.com @Azizocyte

×