Pituitary Tumor

Boris Hristov and Timothy A. Chan

 Background

What is the % of pituitary tumors in relation to all primary brain tumors?

~10%–15% of all primary brain tumors are of pituitary origin.

What % of pituitary tumors are functional vs. nonfunctional?

75% of pituitary tumors are functional, while 25% are nonfunctional.

What are the gender and age predilection for pituitary tumors with symptomatic presentations?

Pituitary tumors with symptomatic presentations occur mostly in females. 70% occur from age 30–50 yrs.

What are some heritable syndromes that predispose to pituitary tumors?

MEN 1 and MEN 2 predispose to pituitary tumors.

What are the embryonic derivatives of the ant pituitary vs. post pituitary?

1. 
   

   Anterior: Rathke pouch

   
   
2. 
   

   Posterior: extension of the 3^rd ventricle

What is the name for the bony structure that houses the pituitary?

The sella turcica houses the pituitary.

What hormones are secreted by the ant pituitary vs. the post pituitary?

1. 
   

   Anterior: prolactin (PL), GH, ACTH, TSH, LH, FSH

   
   
2. 
   

   Posterior: ADH, oxytocin

What is the histo-pathologic description of the cells of nonfunctional tumors?

Histopathologically, the cells of nonfunctional tumors are chromophobic.

What hormones are secreted by basophilic cells? Acidophilic cells?

1. 
   

   Basophilic: ACTH, TSH, LH, FSH

   
   
2. 
   

   Acidophilic: GH, PL

What is the most common functional pituitary tumor? 2^nd most common? 3^rd most common?

Prolactinoma (30%) > GH (25%) > ACTH (~15%)

Which pituitary tumors are more common in males and the elderly? Which are more common in females?

1. 
   

   Males and the elderly: nonfunctioning or GH

   
   
2. 
   

   Females: PL and ACTH secreting

Which are the more common pituitary tumors: micro- or macroadenomas?

Macroadenomas are the more common pituitary tumors.

Which are the most common pituitary tumors in females?

Microadenomas are the most common pituitary tumors in females, particularly those that are PL secreting.

What autosomal dominant syndrome has been associated with pituitary adenomas?

MEN 1 (3 “P’s”: pituitary, parathyroid, pancreas), 11q13 mutant/menin

Which CNs are found in the cavernous sinus?

CNs III–IV, V1–2, and VI are found in the cavernous sinus.

What is Nelson syndrome?

Nelson syndrome is ACTH-secreting adenoma in pts with a Hx of adrenalectomy (pts can develop hyperpigmentation of the skin due to α-melanocyte-stimulating hormone).

What is the most common cause of pituitary dysfunction in adults? Children?

1. 
   

   Adults: pituitary adenoma

   
   
2. 
   

   Children: craniopharyngioma

What histologic features are prominent in prolactinomas?

Calcifications and amyloid deposits are prominent in prolactinomas.

What immuno-histochemical stains are positive in pituitary adenomas?

Synaptophysin, chromogranin, and hormone-specific stains

 Workup/Staging

With what signs/Sx do pts with pituitary tumors present?

Bitemporal hemianopsia, HA, and oculomotor deficits (CNs III–IV, VI, V1–V2)

What is the workup of a pt with a pituitary tumor?

Pituitary tumor workup: H&P (physical: CNs, visual field, endocrinopathy), check of hormone levels, thin-slice MRI, and tissue Dx (transsphenoidal resection)

What is the DDx of a pt with a pituitary mass?

Pituitary tumor, craniopharyngioma, meningioma, glioma, suprasellar germ cell, mets, and benign lesions (cyst, aneurysm, empty sella syndrome)

How do pts with prolactinomas present?

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