PITUITARY TUMORS POWERPOINT PRESENTATION

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1. PITUITARY TUMORS

2. OUTLINE Introduction The Pituitary Gland Definition Risk factors/Etiology Types of Pituitary tumors Clinical manifestations Investigations Treatment Conclusion

3. 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.

4. THE PITUITARY GLAND The pituitary gland is a small, pea-sized gland located at the base of the brain, just below the hypothalamus, housed within a bony structure called the sella turcica ,which is a part of the sphenoid bone of the skull. It is attached to the base of the brain by a stalk, known as the infundibulum. The gland has two parts: the anterior pituitary ( adenohypophysis ) and the posterior pituitary ( neurohypophysis ) The inferior border of the pituitary rests on the floor of the sella turcica, and the superior border is located just under the optic chiasm. The cavernous sinus and carotids are found laterally.

5. PITUITARY HORMONES Anterior Lobe Hormones: Growth Hormone (GH): Stimulates growth, cell reproduction, and cell regeneration. Prolactin (PRL): Promotes lactation (milk production) in breastfeeding women. Adrenocorticotropic Hormone (ACTH): Stimulates the adrenal glands to produce cortisol. Thyroid-Stimulating Hormone (TSH): Stimulates the thyroid gland to produce thyroid hormones. Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH): Regulate reproductive processes including ovulation and sperm production.

6. PITUITARY HORMONE Posterior Lobe Hormones: Oxytocin: Stimulates uterine contractions during childbirth and milk ejection during breastfeeding. Antidiuretic Hormone (ADH) or Vasopressin: Regulates water balance in the body by controlling the amount of water reabsorbed by the kidneys.

7. DEFINITION A pituitary tumor is an abnormal growth of cells in the pituitary gland. There are five mature pituitary cell types in the anterior pituitary: Somatotrophs (growth hormone, GH) Lactotrophs (prolactin, Prl ) Thyrotrophs (thyrotropin or thyroid stimulating hormone, TSH) Gonadotrophs (gonadotrophins or luteinizing hormone, LH; and follicle stimulating hormone, FSH) Corticotrophs (adrenocorticotrophic hormone, ACTH)

8. Tumors that develop in the pituitary gland are usually small, localized, slow-growing masses that start in one type of hormone-producing pituitary cells. Although these tumors almost always are benign (referred to as adenomas), they have the potential to cause significant symptoms by: Producing too much of one of the pituitary hormones Suppressing the normal function of other cells in the pituitary gland Growing large enough to press on the nearby optic chiasm or on parts of the brain itself

9. TYPES Pituitary Adenomas are characterized by size and by what hormones, if any, are secreted . Based on size; Microadenoma: Less than 1 centimeter (10mm) in diameter. These are often incidental findings on imaging tests performed for other reasons and may not cause any symptoms. Macroadenoma: Larger than 1 centimeter (10mm) in diameter. These can cause symptoms due to their size and mass effect on surrounding structures.

10. TYPES Based on Hormonal activity; Functioning (hormone secreting) Adenomas: These tumors produce an excess of one or more hormones, leading to a specific set of symptoms depending on the hormone affected. Examples includes; ACTH-producing tumor Prolactin-producing tumor Growth hormone-producing tumor TSH-producing tumor Non-Functioning Adenomas: These tumors do not produce excess hormones and may not cause any symptoms until they become large enough to press on nearby structures.

11. ETIOLOGY The exact cause of most pituitary tumors remains unknown. However some risk factors involved include: Genetic factors such as somatic mutation and genetic mutation. Certain hereditary conditions such as Multiple Endocrine Neoplasia Type 1 (MEN1).

12. ACTH-PRODUCING ADENOMA This pituitary tumor, which also is called a basophilic adrenocorticotrophic hormone-secreting adenoma, overproduces adrenocorticotrophic hormone (ACTH). ACTH is the pituitary hormone that regulates hormone production by the adrenal gland. This type of pituitary tumor releases too much ACTH into the bloodstream, the extra ACTH overstimulates the adrenal glands to pour out high levels of adrenal glucocorticoids (adrenal hormones) and androgens (male hormones) into the blood. In most cases, an ACTH-producing tumor is small and doesn't grow beyond the sella turcica.

13. Symptoms This tumor causes symptoms of Cushing's disease, a condition caused by prolonged overproduction of adrenal glucocorticoids and androgens. These includes; trunal obesity thin skin, easy bruising, red or purple lines (striae) on the skin of the abdomen, a moon-shaped face, muscle wasting, excess body hair in women, acne, amenorrhea psychiatric symptoms, such as depression and psychosis. Cushing's disease also can trigger osteoporosis, hypertension and diabetes.

14. Treatment Transsphenoidal hypophysectomy: In this procedure, the surgeon removes the pituitary tumor through an incision in the upper portion of the nasal passages. After surgery, levels of glucocorticoid hormones are abnormally low, so the patient typically needs to take supplemental glucocorticoid medication for about 3 to 12 months. This medication gradually is tapered as the body slowly reestablishes a normal working relationship between the pituitary gland and the adrenal glands. If the tumor cannot be completely removed by surgery, radiation therapy may be needed.

15. PROLACTIN PRODUCING TUMOR This prolactin-secreting adenoma (prolactinoma) overproduces the hormone prolactin, which stimulates the breasts to make milk. Prolactin-producing pituitary tumors can develop in both men and women.

16. Symptoms Galactorrhea: Flow of breast milk in a woman who is not pregnant or breast-feeding. Less frequent or no menstrual periods (amenorrhea) Trouble becoming pregnant or an inability to become pregnant (infertility). In men, it causes decreased libido and erectile dysfunction in men

17. Treatment Treatment is determined by the size of the tumor and how much prolactin is being produced. Small tumors sometimes don't need to be treated and can be monitored to see if they change. If treatment is necessary, one of the drugs (long-acting dopamine agonists) can be used: Bromocriptine (Parlodel), Pergolide (Permax) or Cabergoline (Dostinex). These drugs reduce blood levels of prolactin and often shrink the size of the pituitary tumor.

18. Treatment If a prolactinoma is large or produces high levels of prolactin, surgery may be recommended. Surgery also may be needed if medications don't help or the person can't take the medications long term because of side effects. When surgery is needed, the tumor is removed with a procedure called transsphenoidal hypophysectomy. In rare cases, radiation therapy may be needed.

19. GROWTH HORMONE PRODUCING TUMOR This tumor, also is called an eosinophilic growth hormone-secreting adenoma, secretes abnormally large amounts of growth hormone. In children and teenagers, this overproduction of growth hormone causes a condition called giantism . In adults, it causes a condition called acromegaly (abnormal enlargement of the skull, jaw, hands and feet, and other symptoms of abnormal growth). Growth hormone-producing tumors can grow beyond the sella turcica.

20. Symptoms If this tumor develops before puberty, then the child typically has the following symptoms of giantism (also called gigantism): abnormally rapid growth, unusually tall stature, a very large head, coarse facial features, very large hands and feet, and sometimes, behavioral and visual problems.

21. Symptoms If the tumor develops after puberty, then the person has the following symptoms of acromegaly: thick, oily skin coarse features with thick lips and a broad nose prominent cheekbones a protruding forehead and lower jaw a deep voice enlargement of the hands and feet a barrel-shaped chest excessive sweating and pain and stiffness in the joints.

22. Treatment Transsphenoidal hypophysectomy is usually the first choice, often followed by medical therapy with a somatostatin analog to control symptoms. Radiation therapy is used in people who do not respond to surgery or medication.

23. TSH PRODUCING TUMOR TSH-producing pituitary tumors, also known as TSHomas, are abnormal growths of cells in the pituitary gland that secrete thyroid-stimulating hormone (TSH). TSH plays a crucial role in regulating the function of the thyroid gland, which is essential for maintaining metabolism, growth, and development. This unregulated production of TSH stimulates the thyroid gland to produce excessive thyroid hormones (T3 and T4). Elevated levels of T3 and T4 result in clinical hyperthyroidism, which includes a wide range of symptoms and systemic effects.

24. Symptoms Patients with TSHomas may present with symptoms typical of hyperthyroidism, such as: Weight loss despite normal or increased appetite Heat intolerance and sweating Palpitations and tachycardia Nervousness, anxiety, and irritability Tremors Fatigue and muscle weakness Menstrual irregularities in women

25. Treatment Transsphenoidal hypophysectomy can be remove the tumor through the nose and sphenoid bone. This is often the first-line treatment for TSHomas. Medications: Somatostatin analogs are medications that can shrink the tumor and decrease TSH production. They may be used alone or in combination with other therapies. Antithyroid medications are also given to control hyperthyroidism symptoms Radiation therapy may be used to destroy tumor cells, particularly for recurrent or inoperable tumors.

26. NON FUNCTIONING PITUITARY ADENOMA This type of pituitary tumor is an hormonally inactive adenoma. It is slow to produce symptoms. For this reason, this type of tumor tends to grow large before it is discovered. In many cases, a nonfunctioning pituitary adenoma is diagnosed only when it already has grown beyond the sella turcica and has begun to cause problems related to pressure on the optic nerves or brain and affects the production of other pituitary hormones causing hypopituitarism. Typically present with symptoms related to their size and pressure effects on surrounding structures, rather than hormone excess.

27. Symptoms Headache due to direct pressure on pain-sensitive structures in the brain. Hypopituitary symptoms such as Adrenal Insufficiency (Low ACTH): Symptoms include fatigue, weakness, weight loss, low blood pressure, and salt craving. Hypothyroidism (Low TSH): Symptoms include fatigue, weight gain, cold intolerance, constipation, dry skin, and hair loss. Gonadal Dysfunction (Low LH/FSH): In women, this can cause menstrual irregularities or amenorrhea (absence of menstrual periods), infertility, and decreased libido. In men, it can lead to decreased libido, erectile dysfunction, and infertility. Growth Hormone Deficiency: In adults, this can cause increased fat mass, decreased muscle mass, and reduced energy. In children, it can lead to growth failure and short stature.

28. Symptoms They can have symptom related to pressure on the optic chiam such as: Bitemporal Hemianopsia: Loss of peripheral vision in both eyes, often caused by compression of the optic chiasm, which lies just above the pituitary gland. Reduced Visual Acuity: Blurred vision or difficulty seeing, which may progress over time if the tumor continues to grow. Double Vision (Diplopia): If the tumor affects cranial nerves that control eye movement (cranial nerves III, IV, and VI).

29. Treatment Many do not treat nonfunctioning pituitary tumors if the tumor is less than 10 millimeters in diameter. Instead, they monitor the growth of the tumor with periodic MRI scans. Larger tumors are removed surgically using a transsphenoidal hypophysectomy, sometimes followed by radiation therapy to eliminate any remaining tumor. However, not all pituitary tumors can be removed by using this surgical approach, either because the tumor is too large or because it is in a position that is difficult to reach through the nose. Instead, the surgeon must do a procedure called a craniotomy, which removes the tumor through an incision in the front portion of the skull.

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

31. INVESTIGATIONS Thorough Medical History and Physical Examination Magnetic Resonance Imaging (MRI) is the gold standard for visualizing pituitary tumors due to its superior soft-tissue contrast. (CT scans may be used if MRI is contraindicated or unavailable). Blood tests are crucial for assessing hormone levels produced by the pituitary gland and other glands it regulates.These includes: Thyroid function test to evaluate thyroid function. ACTH and cortisol: To assess adrenal function. Prolactin: To assess milk production and fertility. Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) Dynamic funtion tests such as OGTT, Dexamethasone Suppression Test can also be done to further confirm diagnosis.

32. COMPLICATIONS One of the most significant complications is compression of the optic chiasm, which is located just above the sella turcica. This can lead to: Visual Field Defects: Commonly, patients may experience bitemporal hemianopsia, which is the loss of peripheral vision in both eyes. Vision Loss: Severe compression can lead to progressive vision loss and, if untreated, potentially blindness. Growth beyond the sella turcica can affect nearby cranial nerves. Larger tumors may compress parts of the brain, leading to: Headaches: Often due to increased intracranial pressure or direct pressure on pain-sensitive structures. Cognitive Changes: Memory problems, personality changes, or other cognitive disturbances if the frontal lobes or other brain regions are affected. Hypopituitarism: Tumor growth can compress normal pituitary tissue, leading to decreased production of one or more pituitary hormones.

33. CONCLUSION Pituitary tumors are abnormal growths in the pituitary gland, a pea-sized gland at the base of the brain responsible for hormone production. Most pituitary tumors are benign (noncancerous) and can cause symptoms due to hormone imbalances or pressure on nearby structures. Symptoms vary depending on the type of hormone affected but can include vision changes, headaches, fatigue, and changes in weight or physical appearance. Diagnosis involves a combination of blood tests to assess hormone levels, imaging tests to visualize the pituitary gland, and sometimes additional tests to evaluate pituitary function.

34. QUESTIONS 1. The pituitary gland is housed within which bony structure? A. Skull cap B. Sphenoid bone C. Temporal bone D. Frontal bone 2. Which hormone is NOT produced by the anterior pituitary? A. Growth Hormone (GH) B. Prolactin (PRL) C. Adrenocorticotropic Hormone (ACTH) D. Oxytocin 3. Which symptom is associated with TSH-producing tumors? A. Weight gain B. Cold intolerance C. Palpitations D. Reduced sweating 4. What is the most common surgical procedure for removing pituitary tumors? A. Craniotomy B. Transsphenoidal hypophysectomy C. Gamma knife surgery D. Endoscopic third ventriculostomy

35. QUESTIONS 5. What is a pituitary microadenoma? A. Tumor larger than 1 cm in diameter B. Tumor less than 1 cm in diameter C. Non-functioning adenoma D. ACTH-producing tumor 6. Which hereditary condition is associated with a higher risk of pituitary tumors? A. Diabetes B. Multiple Endocrine Neoplasia Type 1 (MEN1) C. Hypertension D. Osteoporosis 7. What is the gold standard imaging technique for visualizing pituitary tumors? A. CT scan B. MRI C. X-ray D. Ultrasound 8. Which condition is caused by excessive production of growth hormone in adults? A. Acromegaly B. Gigantism C. Cushing's syndrome D. Hyperthyroidism

36. QUESTIONS 9. Which dynamic test is used to diagnose acromegaly? A. Oral Glucose Tolerance Test (OGTT) B. Dexamethasone Suppression Test C. Water deprivation test D. ACTH stimulation test 10. Which visual field defect is commonly caused by pituitary tumors? A. Central scotoma B. Bitemporal hemianopsia C. Homonymous hemianopsia D. Quadrantanopia