ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 66 CME2.1 | DOI: 10.1530/endoabs.66.CME2.1

Recognition and assessment of pituitary tumours: what the clinician needs to know

Assunta Albanese

St George’s University Hospitals NHS Foundation Trust, London, UK

Craniopharyngiomas and pituitary adenomas are the most common benign tumours occupying the pituitary fossa. Neoplastic or infiltrative processes of the pituitary area, such as gliomas arising from the optic chiasm and surrounding region, germ cell tumors from the pituitary stalk, and granulomatous diseases, are less common. Pituitary adenomas are classified according to size, functional status, primary cell origin, and hormone secretion (Prolactin, GH, ACTH, TSH and gonadotropins) Prolactinomas are the most common pituitary adenomas in adults and children, and 53% of pediatric pituitary adenomas are found to be prolactinomas. Most pituitary tumours grow very slowly and those discovered by chance ‘incidentalomas’ may not need any active treatment. Large tumours may produce pressure effect on surrounding tissues leading to visual defects, cranial nerve impairment, headaches, rhinorrhea or symptoms of hypopituitarism due to destruction of the pituitary tissue. Hypopituitarism usually has an insidious presentation with generalized malaise, tiredness, loss of appetite, weight loss or gain, decreased mental function, dizziness, poor linear growth, delayed/arrested puberty, primary/secondary amenorrhea and loss of libido. Polyuria and polydipsia can be the presenting symptoms of diabetes insipidus. Hypopituitarism may present acutely following infarction within the pituitary adenomas (pituitary apoplexy) and require immediate medical and neurosurgical attention. Signs and symptoms of hormonal hypersecretion can lead to the diagnosis of functioning micro or macroadenomas. The lecture will focus on the clinical presentation of pituitary tumours and initial endocrine approach. It will highlight some of the more relevant pitfalls encountered while interpreting biochemical results.

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