PITUITARY ADENOMA A presentation in Endocrinology

Endocrinology

1. BS. VI & M.Sc. final
Specialization in
ENDOCRINOLOGY
by
PROF.DR.TAHIRA JABEEN
M.Phil. & Ph.D, UOS
Endocrinologist
Date: 28
th
august 2021
PowerPoint  Lecture Notes Presentation

2. PATHOLOGICAL
EndocrinOLOGY
DISEASE CAUSED BY HORMONAL EMBALENCE s
Date: 28
th
august 2021

3. PATHOLOGY : the science of
the causes and effects of
diseases

4. PITUITARY ADENOMA

5. PITUITARY ADENOMA

18. PITUITARY ADENOMA

19. SUMMARY: Pituitary
Adenomas
Pituitary adenomas arise from the pituitary gland and are by far the most
common growth associated with the gland; they account for 15% of primary
brain tumors and are the third most common intra-cranial tumor after
meningiomas and gliomas. The great majority (over 90%) of pituitary
adenomas are benign slow growing tumors, approximately 5-10% are
somewhat more aggressive (atypical) and less than 1% qualify as pituitary
carcinoma.
From autopsy studies and MRIs of normal individuals, it is known that 10-
20% of the general population has a pituitary adenoma. Most of these tumors
remain small and do not cause significant harm or symptoms; however many
do progress and grow to cause hormonal and neurological problems.

20. Meningioma
At what size should a meningioma be removed?
Image result
Grade III anaplastic meningiomas are
 
malignant
(cancerous). This means they are fast-growing tumors.
In contrast, if the tumor is causing symptoms such as
double vision, weakness in the limbs, blindness,
paralysis or a seizure, then neurosurgeons need to
determine whether surgery is an option. Ideally,
surgical removal of meningioma entails removal of a
one-centimeter margin all the way around the tumor

21. Types of Pituitary Adenomas
Pituitary adenomas are classified by size and
whether they produce pituitary hormones;
Microadenomas are less than 1 cm in diameter
and
 Macroadenomas are over 1 cm in diameter.

22. Pituitary Gland Tumors are abnormal
growths which develop inside the
pituitary gland. Some pituitary gland
tumors result in secreting too much of
hormones which regulate important
functions of the body. Some of these
pituitary gland tumors can also cause
pituitary glands to produce lower levels
of hormones as well. Most pituitary
tumors are benign (noncancerous)
growths which are called adenomas.
Adenomas remain inside pituitary gland
or within the surrounding tissues &
generally do not spread to other parts of
the body. Various options are available
for treating pituitary tumors, including
surgical removal of tumors, controlling
its growth & also management of
hormone levels with help of
medications. Moreover, doctors often
recommend observation or a ‘wait &
watch’ approach while treating pituitary
tumors.

23. Signs & Symptoms of Pituitary Gland
Tumors
Not all pituitary gland tumors are found
to cause signs & symptoms. Pituitary
gland tumors which are functioning &
making hormones can cause a variety of
signs & symptoms depending upon the
hormones they produce. Signs &
symptoms of pituitary gland tumors
which are nonfunctioning & do not make
hormones are related to the size of their
growth & the amount of pressure they
are able to put on other nearby
structures. Large pituitary gland tumors
which measure little less than half-inch
(1 centimeter) or larger are medically
termed macroadenomas, while smaller
tumors are known as microadenomas.
Merely because of the size of
macroadenomas, they are able to put
pressure on normal pituitary gland &
structures located nearby.

24. •Signs & Symptoms Relating to Tumor Pressure – Signs & symptoms of pressure from large
pituitary tumors can include the following.
•Headache
•Loss of vision, particularly peripheral vision loss
•Signs & Symptoms Relating to Hormone Level Changes
•Over-Functioning – Functional pituitary gland tumors can cause overproduction of
hormones. Different types of functional tumors within the pituitary gland can cause specific
signs & symptoms & quite often a combination of them.
•Deficiency – Large pituitary gland tumors can cause hormonal deficiencies whose signs &
symptoms may include the following.
•Weakness
•Nausea & Vomiting
•Feeling Cold
•Sexual Dysfunction
•Less Frequent or No Menstrual Cycles
•Unintended Weight Loss or Weight Gain
•Increased Amounts of Urine

25. Types of Pituitary Gland Tumors
•Adrenocoticotropic Hormone-Secreting (ACTH) Pituitary Tumors – ACTH pituitary tumors produce
adrenocorticotropin hormone which stimulates the adrenal gland so as to make hormone cortisol.
Adrenal glands producing too much cortisol eventually results in Cushing’s syndrome. Signs &
symptoms which are possible due to Cushing’s syndrome include the following.
•Accumulation of fat in midsection & upper back region
•Exaggerated roundness of face
•Thinning of arms & legs
•Bone weakening
•Acne
•High Blood Sugar
•High Blood Pressure
•Anxiety, Irritability or Depression
•Stretch Marks
•Bruising
•Growth Hormone-Secreting Pituitary Tumors – This type of pituitary tumors produce excessive
growth hormones (acromegaly) & which can cause the following signs & symptoms.
•Joint Pain
•Heart Problems
•High Blood Sugar
•Excessive Sweating
•Enlarged Hands & Feet
•Coarsened Facial Features
•Increased Hair on Body
•Misaligned Teeth
•Children & Adolescents may grow too fast and/or too tall

33. Endocrine-active adenomas
Adenomas that make excess hormones (endocrine-active
adenomas) include
 Prolactin-secreting adenomas known as prolactinomas,
Adrenocorticotropic hormone (ACTH) secreting adenomas
causing Cushing’s disease,
Growth hormone (GH) secreting adenomas causing 
acromegaly, and
Thyroid stimulating hormone (TSH) secreting adenomas
causing hyperthyroidism.

37. PITUITARY ADENOMAS LEADS

39. Multiple endocrine neoplasia
type 1 (MEN1)

40. Endocrine-inactive Adenoma
Adenomas that do not make excess hormones are
called endocrine-inactive or Non-Functional Adenomas. Most
adenomas are not genetically inherited; cases of familial
pituitary tumors are rare. Multiple Endocrine Neoplasia
(MEN) type I accounts for less than 5% of cases of pituitary
adenomas. This autosomal dominant condition is
characterized by multiple and sometimes simultaneous
tumors of the pituitary, pancreas and parathyroid glands.
Pituitary adenomas develop in 25% of patients with MEN.
TYPE I

41. What is multiple endocrine neoplasia type 1?
Multiple endocrine neoplasia type 1 (MEN1) is a
hereditary condition associated with tumors of the
endocrine (hormone producing) glands. MEN1 was
originally known as Wermer syndrome. The most
common tumors seen in MEN1 involve the
 
parathyroid
gland,
 
islet cells of the pancreas, and
 
pituitary
gland.
Other endocrine tumors seen in MEN1 include
 
adrenal
cortical tumors,
 
neuroendocrine tumors 
(previously
called carcinoid tumors), and
rare
 
pheochromocytomas, as well as tumors in other
parts of the digestive tract.

47. Doctors and Specialists Who Treat
Pituitary Adenomas (Tumors)
Pituitary tumors and related hormonal
disorders are complex in their diagnosis and
treatment , experienced specialists to achieve
optimal outcomes.
They assembled a highly experienced team
of experts who work closely together,
diagnosis to treatment, as well as education
and support. 

48. TREATMENT

49. - There are several types of treatment available being
determining factors as to the most suitable course of
action. These treatments are surgery, medication or
radiation-therapy.
- Medication is less intrusive of treatments where as
surgery requires that the tumor be removed through
the nasal cavity or in very rare cases through the front
of the skull.

50. Endoscopic Transsphenoidal Surgery
 

51. A pituitary gland tumor is removed via
endoscopic transsphenoidal surgery.
This is a surgery performed through the
nose and sphenoid sinus. An endoscope
is used to perform this procedure.

54. SURGICALLY TREATMENT OF
PITUITARY TUMOR

56. Pituitary Adenoma Neurosurgeons and Specialists
At the Pacific Pituitary Disorders have one of the world’s
largest experiences in endoscopic endonasal
transsphenoidal surgery for all types of pituitary
adenomas including acromegaly, Cushing’s disease,
prolactinomas, non-functional adenomas, pituitary
apoplexy and residual or recurrent adenomas.By
incorporating leading-edge technology and
instrumentation with proven surgical experience of over
2,000 endonasal surgeries, our pituitary tumor
specialists led by neurosurgeons, and
ENT/Otolaryngologist make pituitary surgery safer, less
invasive and more effective.