What is a Pituitary tumor? The pituitary gland is a pea sized endocrine gland located at the base of the brain. A pituitary Tumor is caused by an abnormal growth in the pituitary gland. The tumor is benign and most people are unaware they have it because there are very little symptoms. The hormone releasing cells of the pituitary gland can be damaged.
The symptoms can be: Headache Lethargy: weariness, lack of energy Nasal Drainage Nausea and vomiting Problems with the sense of smell Visual changes such as -Double vision -Drooping eyelids -Visual field loss Figure 3 These symptoms may occur suddenly and can be very severe.
The symptoms can lead to: Hyperthyroidism: a condition in the thyroid gland that produces to much thyroid hormone. Crushing syndrome: When your body is exposed to high levels of the hormone cortisol. Gigantism: abnormal large growth due to excess of the growth hormone during childhood. Nipple discharge: tenderness, skin changes, changes in shape or discharge from the nipple portion of the breast. Figure 4 Figure 5
Treatments can include: Surgery especially if the tumor is pressing on the optic nerves. Can be removed through the nose or sinuses. If it doesn’t work through the nose or sinuses it will have to be removed through the skull. Radiation therapy can be used to shrink the tumor. - It can be used for people who cannot be put through surgery. Figure 6 Figure 7
Medications: These medications can also shrink the tumors: • Bromocriptine is the first line therapy for tumors that release prolactin. With this dug it decreases the prolactin and shrinks the tumor. • Octreotide is used for tumors that release growth hormone but only used when surgery cant be curable. Bromocriptine is used to treat symptoms of high levels of a natural substance called prolactin in the body
Complications: If the optic nerve has serious damage you can go blind. The tumor removal may cause permanent hormone imbalances. The affected hormones may need to be removed.
Exams and tests:Physical Examinations and test will include: Cortisol levels -Dexamethasone Suppression test: measures the response of the adrenal glands to the ACTH. -Urine Cortisol: measures the amount of the steroid hormone cortisol in the urine Follicle-stimulating hormone levels: hormones released by the anterior pituitary gland. Insulin growth factor-1 levels Luteinizing hormone levels: measures the amount of luteinizing hormone
Exams and tests continued: Serum prolactin levels: measures the amount of prolactin in the blood Testosterone/estradiol levels Thyroid hormone levels -Free T4 test: hormone produced by the thyroid gland. A laboratory test can be done to measure the amount of T4 in your blood. -TSH test: measures the amount of thyroid stimulating hormone in your blood.
Random Facts: Can occur to people of all ages, most frequent in children and older adults. Most common primary brain tumors consist of; In ages 15-19, pilocytic astrocytomas followed by pituitary tumors. In ages 20-34, pituitary followed by meningioma tumors. Pituitary tumors represent 8.4% of all primany brain tumors. Pituitary adenomas have separate names based on their size. A microadenoma is less then 1 centimeter in diameter A macroadenoma is larger then 1 centimeter in size Pituitary adenomas are relatively common, occurring in 1 out of every 1000 adults.
EXAM METHOD Tangent screen exam Here the patient is asked to sit 1 meter (approximately 3 feet) from a screen with a target on the center. The eye that isnt tested is covered during the exam. While the patient stares at the target the examiner will move an object toward the patients visual field. The patient signals the examiner when the object comes into view. This exam allows the patients visual field to be mapped.
QUIZ TIME!QUIZ TIME1. Explain what a pituitary tumor is?2. Name 3 of the symptoms.3. How can the tumor be removed?4. If the _____ ______ has serious damage you can go blind.5. How large is a macroadenoma?*BONUS* : Pituitary tumors represent __% of all primary braintumors
Picture Resources: FIGURES 1 & 2- http://www.google.com/imgres?q=pituitary+tumor&hl=en&gbv=2&biw=812&bih=374&tbm=isch&tbnid=jl6Wh- U2vXNBnM:&imgrefurl=http://www.cedars-sinai.edu/Patients/Programs-and-Services/Pituitary-Center/Diagnostic- Imaging/Pituitary-MRIs.aspx&docid=XcMDFKUFo8ZZFM&imgurl=http://www.cedars-sinai.edu/Patients/Programs- and-Services/Pituitary-Center/Diagnostic-Imaging/Images/coronalPit-MRI_rev_web-ready- 37301.jpg&w=466&h=432&ei=4CJJT_6kK5HDsQLuk_TqCA&zoom=1&iact=hc&vpx=69&vpy=21&dur=1529&hovh=216 &hovw=233&tx=133&ty=233&sig=111409954476902108896&page=3&tbnh=111&tbnw=95&start=18&ndsp=15&ved =1t:429,r:0,s:18 FIGURE 3- http://www.eyeptosis.com/ FIGURE 4- medicinenet.com FIGURE 5- - http://www.netterimages.com/image/12845.htm FIGURE 6- http://healthlob.com/2011/05/radiation-therapy/ FIGURE 7- Dizon, M. N. and D. L. Vesely. "Gonadotropin-secreting Pituitary Tumor Associated with Hypersecretion of Testosterone and Hypogonadism After Hypophysectomy." Endocrinology Practice 3 (May-June 2002): 225–231 FIGURES 8 & 9-http://www.emedicinehealth.com/drug-cabergoline/article_em.htm FIGURE 10- http://acromegaly.wordpress.com/2009/02/07/started-treatment-for-acromegaly/
Resources 1. Melmed S, Kleinberg D. Anterior pituitary. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 8. 2. 1. Biller BMK, Grossman AB, Stewart PM, et al. Treatment of adrenocorticotropin-dependent Cushings syndrome: a consensus statement. J Clin Endocrinol Metab. 2008;93:2454-2462. 3. National endocrine and metabolic diseases information service. National Institutes of Health. NIH Publication No. 08-3007. Cushings Syndrome. http://endocrine.niddk.nih.gov/pubs/cushings/cushings.htm. Published July 2008. Accessed November 10, 2010. 4. Pituitary tumors information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/pituitary_tumors/pituitary_tumors.htm. Accessed April 15, 2010. 5. Pituitary tumors. American Cancer Society. http://documents.cancer.org/6028.00/6028.00.pdf. Accessed April 15, 2010. 6. Pituitary tumors. American Brain Tumor Association. http://www.abta.org/Tumor_&_Treatment_Info/Pituitary_Tumors/233. Accessed April 15, 2010. 7. Pituitary Tumors Treatment. National Cancer Institute. http://www.cancer.gov/cancerinfo/pdq/treatment/pituitary. Accessed April 15, 2010 8. Ari S. Eckman, MD, Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.