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Pituitary tumours

Medicine > Endocrine & metabolic

Background knowledge 🧠

Definition

  • Pituitary tumours are abnormal growths in the pituitary gland, which may affect hormone production.
  • They can be functional (hormone-secreting) or non-functional (non-secreting).

Epidemiology

  • Pituitary tumours account for 10-15% of all intracranial tumours.
  • Most commonly diagnosed in adults aged 30-50.
  • Higher prevalence in women.
  • Incidentalomas (tumours found incidentally) are common.

Aetiology and Pathophysiology

  • Most pituitary tumours are benign adenomas.
  • Causes include genetic mutations and familial syndromes (e.g., MEN1).
  • Tumours can cause symptoms by hormone overproduction or compression of adjacent structures.
  • Non-functional adenomas often present due to mass effect.

Types

  • Prolactinomas: secrete prolactin.
  • Somatotroph adenomas: secrete growth hormone.
  • Corticotroph adenomas: secrete ACTH.
  • Thyrotroph adenomas: secrete TSH.
  • Gonadotroph adenomas: secrete LH and FSH.
  • Non-functional adenomas: do not secrete hormones.

Clinical Features 🌡️

Symptoms

  • Headaches.
  • Visual disturbances (bitemporal hemianopia).
  • Hormonal imbalances (e.g., amenorrhoea, galactorrhoea, acromegaly).
  • Fatigue.
  • Weight changes.
  • Polydipsia and polyuria (if diabetes insipidus).

Signs

  • Visual field defects (bitemporal hemianopia).
  • Cranial nerve palsies.
  • Signs of hormone excess or deficiency.
  • Pituitary apoplexy (acute haemorrhage).
  • Hyperpigmentation (if ACTH excess).
  • Signs of hypopituitarism.

Investigations 🧪

Tests

  • Hormonal assays: prolactin, GH, IGF-1, ACTH, cortisol, TSH, free T4, LH, FSH.
  • MRI of the pituitary gland: gold standard for imaging.
  • Visual field testing.
  • Dynamic endocrine testing (e.g., dexamethasone suppression test, oral glucose tolerance test).
  • Biopsy in rare cases.

Management 🥼

Management

  • Transsphenoidal surgery: first-line for most pituitary adenomas.
  • Medications: dopamine agonists (prolactinomas), somatostatin analogues (GH-secreting tumours).
  • Radiotherapy: for residual or recurrent tumours.
  • Hormone replacement therapy: for hypopituitarism.
  • Regular follow-up with endocrinology.
  • Management of complications (e.g., adrenal crisis).

Complications

  • Hypopituitarism.
  • Visual loss.
  • Pituitary apoplexy.
  • Diabetes insipidus.
  • Recurrence of tumour.
  • Radiation-induced complications.

Prognosis

  • Generally good with appropriate treatment.
  • Regular follow-up needed to monitor for recurrence.
  • Hormone replacement may be lifelong.
  • Potential for normal life expectancy.
  • Quality of life can be affected by hormone deficiencies and treatment side effects.

Key Points

  • Pituitary tumours can be functional or non-functional.
  • Symptoms arise from hormone imbalances or mass effect.
  • MRI is the imaging modality of choice.
  • Management includes surgery, medications, and radiotherapy.
  • Long-term follow-up is essential.

References

  • NICE Guidelines (https://www.nice.org.uk/guidance/ng35).
  • NHS Inform (https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/pituitary-tumours).

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Endocrine & metabolic