Pituitary tumor and panhypopituitarism

Hormone of anterior pituitary

PRL, GH, ACTH, FSH, LH, TSH

Hormone of posterior pituitary

ADH, oxytocin

What is pituitary adenoma

Benign tumor from any pituitary cell type, commonly associated with MEN1, micro <10mm, macro >10mm, most are functional

Mass effect symptoms

Headache, bitemporal hemianopia, compression of cavernous sinus, hypopituitarism from hemorrhage or infarction of mass

Cavernous sinus has what nerves

III, IV, V1, VI

Signs of cavernous sinus compression

Ophthalmoplegia and diplopia + facial numbness

Functional adenoma symptom

Symptom of hormone overproduction → Changes based on what hormone → Most common is prolactinoma

Diagnosis of pituitary adenoma

MRI brain → good for soft tissue, CT → Hemorrhage (apoplexy)

Etiologies of hyperprolactinemia

Prolactinoma, primary hypothyroid (High TRH stimulate PRL), DOPAr antagonist, stalk obstruction

Symptoms of hyperprolactinemia

Galactorrhea, amenorrhea, infertility, impotence, decrease libido, decreased bone density

How does hyperPRL cause amenorrhea, infertility and low bone density

Inhibit GnRH → No LH/FSH → No ovulation or menstruation + low estrogen that inhibit osteoclast

Hyperprolactinemia investigation

PRL >200, TSH and T4

Hyperprolactinemia treatment

DOPA agonist (cabergoline), mass resection

Acromegaly and gigantism symptoms

Deepened voice, snoring, enlarged hand, finger and feet, carpal tunnel, oily, hyperhidrosis, cardiomegaly, thyroid enlargement

Complication of gigantism and acromegaly

Cardiomyopathy from hypertrophy, arrhythmia, sleep apnea, glucose intolerance, colonic polyp → cancer

Investigation for somatotrophic adenoma

High IGF-1 to screen, glucose tolerance to diagnose

Somatotroph adenoma treatment

Somatostatin analogue (octreotide, lanreotide), GHr antagonist (pegvisomant)

What is hypopituitarism

Low anterior pituitary hormone; GH → LH/FSH → TSH → ACTH; prolactin def is rare

Hypopituitarism treatment

Hormone replacement → Hydrocortisone/prednisone, levothyroxine, sex steroid, recombinant GH

What is Sheehan syndrome

Massive blood loss in childbirth → Infarction of pituitary; Hx is mother that cannot breastfeed after postpartum hemorrhage

What is pituitary apoplexy

Hemorrhage from tumor → Lead to CVS collapse and death