Pituitary tumor

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Pituitary Tumor Microchapters

Patient Information

Overview

Classification

Pituitary adenoma
Pituitary carcinoma
Craniopharyngioma
Urethritis
Asymptomatic bacteriuria

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.; Ammu Susheela, M.D. [2]

Overview

Pituitary tumors are tumors that occur in the pituitary gland and account for about 10% of intracranial neoplasms. Pituitary adenomas are often remain undiagnosed. Small pituitary tumors are found in 6 to 24 percent of adults at autopsy. Pituitary tumors arise within the anterior lobe (adenohypophysis) of the gland. They may be classified according to the size of the tumor and type of hormone secretion. Pituitary adenomas subtypes include corticotrophic, somatotrophic, thyrotrophic, gonadotrophic, and lactrotrophic adenomas. There are no established causes for pituitary tumors. Patients with pituitary tumors may progress to develop lethargy, headache, nausea, and vomiting. Common complications of pituitary adenoma include bitemporal hemianopia, anosmia, acromegaly, gigantism, and Cushing's syndrome. Prognosis is generally good, and approximately 18% of patients with macroadenoma require further treatment. Pharmacologic medical therapy is recommended among patients with prolactinoma, thyrotrophic, somatotrophic, and adrenocorticotropic adenomas. The transsphenoidal microsurgical approach is the mainstay of treatment for growth hormone producing adenomas, adrenocorticotropic hormone-(ACTH) producing adenomas, and macroadenomas.

Classification

Pituitary tumors classified according to the 2017 World Health Organization (WHO):[1]

 
 
 
 
 
 
 
 
 
 
 
 
Pituitary adenomas
 
Somatotroph adenoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pituitary carcinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pituitary blastoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tumors of posterior pituitary
 
Pituicytoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pituitary tumors
 
 
 
 
Craniopharyngioma
 
Adamantinomatous craniopharyngioma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mesenchymal and stromal tumors
 
Meningioma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hematolymphoid tumors
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Germ cell tumors
 
Germinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Secondary tumors
 
 
 
 
 
 
 

Differential Diagnosis

Disease Clinical Findings Laboratory Findings Management
Somatotroph adenoma:

Acromegaly

Clinical features of acromegaly are due to high level of human growth hormone (hGH):
Corticotroph adenoma:

Cushing's syndrome

Clinical features of Cushing's syndrome are due to increased levels of cortisol:
Hypothyroidism Clinical features of hypothyroidism are due to deficiency of thyroxine:
Chronic renal failure There are no pathognomonic symptoms associated with chronic renal failure. Common non-specific symptoms of chronic renal failure include: Urinalysis:

Fluid and electrolyte disturbances:

Endocrine and metabolic disturbances:

Hematologic abnormalities:

Liver disease: Cirrhosis The clinical features of liver cirrhosis are very nonspecific. These include:
Seizure disorder The clinical features of seizure disorder may include:
  • Change in alertness, orientation and time perception
  • Mood changes, such as unexplainable fear, panic, joy, or laughter
  • Changes in sensation of the skin, usually spreading over the arm, leg, or trunk
  • Vision changes, including seeing flashing lights
  • Rarely, hallucinations (seeing things that aren't there)
  • Falling, loss of muscle control, occurs very suddenly
  • Muscle twitching that may spread up or down an arm or leg
  • Muscle tension or tightening that causes twisting of the body, head, arms, or legs
  • Shaking of the entire body
  • Tasting a bitter or metallic flavor
Medication-induced Clinical features of hyperprolactinemia after a specific period of regular medication ingestion
  • Discontinuation of the medication for 3 days and remeasurement of prolactin levels[2]
  • Change to alternate medication

References

  1. Lopes MBS (2017). "The 2017 World Health Organization classification of tumors of the pituitary gland: a summary". Acta Neuropathol. 134 (4): 521–535. doi:10.1007/s00401-017-1769-8. PMID 28821944.
  2. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA; et al. (2011). "Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline". J Clin Endocrinol Metab. 96 (2): 273–88. doi:10.1210/jc.2010-1692. PMID 21296991.



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