A young lady presents with gradually worsening headaches, visual disturbance, and lack of
energy. MRI shows 15mm tumor in the pituitary fossa. What is the tx of choice?
a. Radiotherapy
b. Octreotide
c. Reassurance and f/u after 6m
d. Surgery
e. Chemotherapy
answer: D
This is a case of macroadenoma producing a mass effect and hormone deficiency
Pituitary tumours which are producing pressure symptoms on the optic chiasm are treated by intracapsular removal through a trans - sphenoidal (or occasionally transcranial) route. If there were signs of it being a prolactinoma (e.g. galactorrhea) we could treat it with bromocriptine.
microadenoma <1 cm; macroadenoma ≥1 cm
Can present with:
1. Local mass effects:
a Visual field disturbance (bitemporal hemianopia) due to compression of the optic chiasm.
b Headache , due to expansion of the pituitary fossa with dural stretching, erosion into the paranasal air sinus, and/or haemorrhage within the tumour (pituitary apoplexy).
2. Hormone deficiency (hypopituitarism): as the tumour grows, it compresses the normal pituitary around the tumour, resulting in educed production of anterior pituitary hormones. Deficiency tends to first suppress luteinizing and growth hormone production, followed in sequence by loss of thyroid -
stimulating hormone (TSH), adrenocorticotrophic hormone (ACTH) and follicle - stimulating hormone (FSH). The posterior pituitary hormones are rarely affected.
3. Hormone excess: hormone - secreting adenomas may present with symptoms from the hormone, for example Cushing ’s disease from ACTH excess.
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