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Pituitary Tumour Classification and Clinical Outcomes

Pituitary Tumour: Classification and clinical outcomes Functional tumour: Secretes excess Non-functional tumour (30%) (lack of hormone-producing cells or due to gene mutations) Authors: Chris Oleynick Caroline Kokorudz Reviewers: Amyna Fidai Laura Byford- Richardson Joseph Tropiano Julia Gospodinov Luiza Radu Hanan Bassyouni* * MD at time of publication hormones (70%) Relative abundance & predisposition for lactotroph (prolactin-producing), somatotroph (growth hormone – producing), thyrotroph (TSH producing) & corticotroph (adrenocorticotropic hormone – producing) cells to form adenomas (epithelial cell tumours) ↑ Lactotroph cells ↑ Prolactin (PRL) (most common) Hyper- prolactinemia (high prolactin blood levels) ↑ Somatotroph cells ↑ Growth hormone (GH) Acromegaly* (excess tissue growth & metabolic dysfunction) ↑ Corticotroph cells ↑ Adrenocortico- tropic hormone (ACTH) Cushing disease* (prolonged exposure to excess cortisol) ↑ Thyrotroph cells ↑ Thyroid stimulating hormone (TSH) Central hyper- thyroidism (↑ T4 & T3) Large size (macro) (>10mm on MRI) may cause mass effect (tissue compression from mass) Small size (micro) (<10mm on MRI) unlikely to cause mass effect (compression to surrounding structures) Asymptomatic Headache Nausea & vomiting Compresses pituitary gland & impairs blood supply & function of pituitary cells Impinges pituitary stalk & disrupts hormone transport from hypothalamus to the anterior and posterior pituitary Compresses surrounding structures ↑ Pressure & stretching of dural mater Stretching of the meninges activates mechanoreceptors (stretch receptors) in GI tract Pituitary hormone deficiency (typically in left-right order with mass effect): Dopamine release obstruction ↓ Inhibition of prolactin secretion Antidiuretic hormone (ADH) obstruction Inferior tumour growth Growth into sphenoid sinus Lateral growth of the tumor compresses surrounding cranial nerves Superior tumour growth ↓ GH ↓ Protein production & muscle cell proliferation ↓ Luteinizing hormone (LH) (triggers ovulation & sex hormone synthesis) & follicle stimulating hormone (FSH) (stimulates ovarian follicles & sperm growth) ↓ (TSH) ↓ ACTH (stimulates cortisol & androgen release) Cranial nerve (CN) II (optic) ↓ Visual acuity Diplopia (double vision) CN III, (oculomotor) IV (trochlear), or VI (abducens) Ptosis* (drooping upper eyelid) CN V (trigeminal) branches V1 & V2 Facial numbness Ophthalmoplegia (eye muscle paralysis) Compresses optic chiasma Bitemporal hemianopsia (decreased lateral peripheral vision) Tumour extends into hypothalamus Hypothalamic dysfunction due to damage to hypothalamic cells Disruption of multiple regulatory systems (i.e. sleep-wake cycles, appetite, temperature) Tumour occludes ventricles Tumour obstructs CSF flow ↑ Intracranial pressure Hydrocephalus* (abnormal buildup of CSF in ventricles of the brain) and papilledema Bacteria migrates from sinus flora into sphenoid sinus Cerebrospinal fluid (CSF) leaks into throat Post-nasal drip and nasopharyngeal mass Stunted growth and short stature in children ↓ Muscle mass & fatigue Diabetes insipidus* (excessive urination & extreme thirst) Central hypothyroidism* (↓ T4 & T3) Hyperprolactinemia Meningitis* (inflammation of the meningeal layers of central nervous system) *See relevant Calgary Guide slide Hypogonadotropic hypogonadism (↓ Sex hormones) Adrenal insufficiency* (↓ 8 AM cortisol) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Oct 1, 2027; updated Jan 5, 2025 on www.thecalgaryguide.com