Pituitary tumors

Pituitary tumors

1. Ratheesh.R SLMGNC Pituitary Tumors

2. Introduction Pituitary tumors are common neoplasms , and recognition of their presentation is critical since a favorable therapeutic outcome is dependent on early identification of the lesion. Pituitary tumors constitute 10-15% of all diagnosed intracranial tumors, 90% of which are adenomas.

3. definition Abnormal proliferation of cells on target tissue or on local structures surrounding the pituitary gland.

4. types Typically, pituitary tumors are characterized by size and by what hormones, if any are secreated . Size: Micro adenoma- less than 10mm wide. Macro adenoma- Greater than 10mm wide. Functionally: Hormone secreting- Exaggerated hormone activity - May secrete multiple hermones . Non-Secreting -Diminished hormone activity.

5. Etiology Unknown Uncontrolled cell growth in the pituitary gland, which creates a tumor Certain hereditary conditions Such as multiple endocrine neoplasia

6. Clinical manifestation Headache. Some loss of vision. Loss of body hair. In women, less frequent or no menstrual periods or no milk from the breasts. In men, loss of facial hair, growth of breast tissue, and impotence. In women and men, lower sex drive. In children, slowed growth and sexual development.

7. Cont…. Too much prolactin may cause: Headache. Some loss of vision. Less frequent or no menstrual periods or menstrual periods with a very light flow. Trouble becoming pregnant or an inability to become pregnant . Lower sex drive. Flow of breast milk in a woman who is not pregnant or breast-feeding.

8. Cont…. Too much ACTH may cause: Headache. Some loss of vision. Weight gain in the face, neck, and trunk of the body, and thin arms and legs. A lump of fat on the back of the neck. Thin skin that may have purple or pink stretch marks on the chest or abdomen. Growth of fine hair on the face, upper back, or arms. Bones that break easily. Anxiety, irritability, and depression.

9. Cont…. Too much growth hormone may cause: Headache. Some loss of vision. In adults, acromegaly (growth of the bones in the face, hands, and feet). In children, the whole body may grow much taller and larger than normal. Tingling or numbness in the hands and fingers. Snoring or pauses in breathing during sleep. Joint pain. Sweating more than usual. Dysmorphophobia (extreme dislike of or concern about one or more parts of the body).

10. Cont…. Too much thyroid-stimulating hormone may cause: Irregular heartbeat. Weight loss. Trouble sleeping. Frequent bowel movements. Sweating.

11. Cont…. Other general signs and symptoms of pituitary tumors: Nausea and vomiting. Confusion. Dizziness. Seizures. Runny or "drippy" nose (cerebrospinal fluid that surrounds the brain and spinal cord leaks into the nose).

12. Diagnostic evaluation History collection Physical examination CT scan MRI Skull films Serum hormone level Provocative Testing Neurological exam Visual field exam Twenty-four-hour urine test Biopsy

13. Medical management Radiation therapy Hormone replacement therapy Chemotherapy Systematic Treatment

14. Surgical management Hypophysectomy - Removal of Pituitary. Frontal Craniotomy- Uncommon approach except where tumor occupies broad area. Transspenoidal Hypophysectomy - - Directapproach through the sinus and nasal cavity.

15. complication Severe disability Death due to stroke, blindness, imbalance of TSH, ACTH or ADH. Transient or permanent Diabetes insipidus . Hypo parathyroidism Adreno cortical insufficiency.

16. Nursing diagnosis Disturbed body image related to enlargement of body parts as manifested by enlarged hands, feet and jaw.  Disturbed sensory perception related to enlarged pituitary gland as manifested by protrusion of eye balls. Disturbed sleeping pattern related to soft tissue swelling as manifested by verbalization of the patient about insomnia. Fluid volume deficit related to polyuria as manifested by excessive thirst of the patient.  Anxiety related to change in appearance and treatment as manifested by verbalization of the patient about body appearance.