Pituitary adenoma overview: Difference between revisions
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==Overview== | ==Overview== | ||
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'''Pituitary adenomas''' are [[tumor]]s that occur in the [[pituitary gland]], and account for about 10% of intracranial [[neoplasia|neoplasms]]. They often remain undiagnosed, and small pituitary tumors are found in 6 to 24 percent of adults at autopsy. | '''Pituitary adenomas''' are [[tumor]]s that occur in the [[pituitary gland]], and account for about 10% of intracranial [[neoplasia|neoplasms]]. They often remain undiagnosed, and small pituitary tumors are found in 6 to 24 percent of adults at autopsy. | ||
Pituitary adenomas arise within the anterior lobe (adenohypophysis) of the gland. Tumors less than 1 cm are called micro adenomas. Clinical symptoms depend on whether the tumor is secreting or nonsecreting. Nonsecreting adenomas grow and compress adjacent structures, most commonly causing a bitemporal hemianopsia due to chiasmatic compression. Lateral extension into the cavernous sinuses can result in cranial nerve palsies. | Pituitary adenomas arise within the anterior lobe (adenohypophysis) of the gland. Tumors less than 1 cm are called micro adenomas. Clinical symptoms depend on whether the tumor is secreting or nonsecreting. Nonsecreting adenomas grow and compress adjacent structures, most commonly causing a bitemporal hemianopsia due to chiasmatic compression. Lateral extension into the cavernous sinuses can result in cranial nerve palsies. | ||
==Historical Perspective== | |||
Pituitary adenoma was first described by Pierre Marie, a French neurologist In 1886. | |||
==Classification== | |||
Pituitary adenoma may be classified according to the size of the adenoma and type of hormone secretion, subtypes include [[corticotrophic]], [[somatotrophic]], [[thyrotrophic]], [[gonadotrophic]], and [[lactrotrophic]] adenomas. | |||
==Pathophysiology== | |||
On gross pathology, a well circumscribed [[suprasellar]] mass is a characteristic finding of pituitary adenoma. | |||
On microscopic histopathological analysis, the lack of [[reticulin]] fiber network among the cells is a characteristic finding of pituitary adenoma. | |||
==Causes== | |||
There are no established causes for Pituitary adenoma. | |||
==Differential Diagnosis== | |||
Pituitary adenoma must be differentiated from other diseases such as [[craniopharyngioma]], [[meningioma]], [[arachnoid cyst]], and pituitary carcinoma. | |||
==Epidemiology and Demographics== | |||
In the USA, the incidence pituitary adenoma is approximately 3.12 per 100,000 individuals. The prevalence of pituitary adenoma is approximately 100 per 100,000 individuals worldwide. | |||
==Risk Factors== | |||
The most potent risk factor in the development of pituitary adenoma is a family history of either pituitary tumor, multiple endocrine neoplasia type 1 ([[MEN1]]), or [[McCune-Albright syndrome]]. | |||
==Pituitary adenoma natural history, complications, and prognosis== | |||
Patients with pituitary adenoma may progress to develop [[lethargy]], [[headache]], [[nausea]], and [[vomiting]]. Common complications of pituitary adenoma include [[bitemporal hemianopia]] , [[anosmia]], [[acromegaly]], [[gigantism]] and [[Cushing's syndrome]]. | |||
Prognosis is generally good, and approximately 18% of patients with macroadenoma require further treatment. | |||
==Diagnosis== | |||
===Staging=== | |||
According to American Joint Committee on Cancer classification and staging system for pituitary tumors there is no staging system available for pituitary adenoma.<ref name=National Cancer institute> Pituitary adenoma (2015). http://www.cancer.gov/types/pituitary/hp/pituitary-treatment-pdq#section/_96. Accessed on 9 28 2015.</ref> | |||
===History and Symptoms=== | |||
The hallmark of pituitary adenoma is increased intracranial pressure. A positive history of [[visual field defect]], [[headache]], and menstrual irregularities is suggestive of pituitary adenoma. The most common symptoms of pituitary adenoma include [[galactorrhea]], [[oligomenorrhea]] , [[erectile dysfunction]], and loss of [[libido]]. | |||
==Physical Examination== | |||
The presence of [[altered mental status]], [[nausea]], [[lethargy]] and visual filed defect ([[bitemporal hemianopsia]]) on physical examination is suggestive of pituitary adenoma. | |||
==Laboratory Findings== | |||
Laboratory findings consistent with the diagnosis of pituitary adenoma include elevated serum prolactin level and elevated or decreased serum level of other pituitary hormones. | |||
===CT=== | |||
Head CT scan may be helpful in the diagnosis of pituitary adenoma. Findings on CT scan suggestive of pituitary adenoma include a large [[suprasellar]] mass that invade surrounding structures, [[calcification]], and rarely [[hemorrhage]]. | |||
===MRI=== | |||
On brain MRI, pituitary adenoma is characterized by a large mass with heterogeneous signal. Other findings may include remodeling of the floor of the [[sella]] and deviation of the pituitary infundibulum to the opposite side. | |||
===Other Imaging Studies=== | |||
Historically, before the advent of MRI, the pituitary was imaged by lateral skull x-rays to look for remodelling of the pituitary fossa.<ref name=radio>Pituitary Microadenoma. Dr Amir Rezaee and Dr Frank Gaillard. Radiopaedia.org 2015. http://radiopaedia.org/articles/pituitary-microadenoma</ref> | |||
===Other Diagnostic Studies=== | |||
[[Inferior petrosal sinus|Inferior petrosal sinus sampling]] may be performed to detecthormonally active pituitary microadenoma. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
Revision as of 21:03, 1 October 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]
Overview
Pituitary adenomas are tumors that occur in the pituitary gland, and account for about 10% of intracranial neoplasms. They often remain undiagnosed, and small pituitary tumors are found in 6 to 24 percent of adults at autopsy. Pituitary adenomas arise within the anterior lobe (adenohypophysis) of the gland. Tumors less than 1 cm are called micro adenomas. Clinical symptoms depend on whether the tumor is secreting or nonsecreting. Nonsecreting adenomas grow and compress adjacent structures, most commonly causing a bitemporal hemianopsia due to chiasmatic compression. Lateral extension into the cavernous sinuses can result in cranial nerve palsies.
Historical Perspective
Pituitary adenoma was first described by Pierre Marie, a French neurologist In 1886.
Classification
Pituitary adenoma may be classified according to the size of the adenoma and type of hormone secretion, subtypes include corticotrophic, somatotrophic, thyrotrophic, gonadotrophic, and lactrotrophic adenomas.
Pathophysiology
On gross pathology, a well circumscribed suprasellar mass is a characteristic finding of pituitary adenoma. On microscopic histopathological analysis, the lack of reticulin fiber network among the cells is a characteristic finding of pituitary adenoma.
Causes
There are no established causes for Pituitary adenoma.
Differential Diagnosis
Pituitary adenoma must be differentiated from other diseases such as craniopharyngioma, meningioma, arachnoid cyst, and pituitary carcinoma.
Epidemiology and Demographics
In the USA, the incidence pituitary adenoma is approximately 3.12 per 100,000 individuals. The prevalence of pituitary adenoma is approximately 100 per 100,000 individuals worldwide.
Risk Factors
The most potent risk factor in the development of pituitary adenoma is a family history of either pituitary tumor, multiple endocrine neoplasia type 1 (MEN1), or McCune-Albright syndrome.
Pituitary adenoma natural history, complications, and prognosis
Patients with pituitary adenoma may progress to develop lethargy, headache, nausea, and vomiting. Common complications of pituitary adenoma include bitemporal hemianopia , anosmia, acromegaly, gigantism and Cushing's syndrome. Prognosis is generally good, and approximately 18% of patients with macroadenoma require further treatment.
Diagnosis
Staging
According to American Joint Committee on Cancer classification and staging system for pituitary tumors there is no staging system available for pituitary adenoma.
History and Symptoms
The hallmark of pituitary adenoma is increased intracranial pressure. A positive history of visual field defect, headache, and menstrual irregularities is suggestive of pituitary adenoma. The most common symptoms of pituitary adenoma include galactorrhea, oligomenorrhea , erectile dysfunction, and loss of libido.
Physical Examination
The presence of altered mental status, nausea, lethargy and visual filed defect (bitemporal hemianopsia) on physical examination is suggestive of pituitary adenoma.
Laboratory Findings
Laboratory findings consistent with the diagnosis of pituitary adenoma include elevated serum prolactin level and elevated or decreased serum level of other pituitary hormones.
CT
Head CT scan may be helpful in the diagnosis of pituitary adenoma. Findings on CT scan suggestive of pituitary adenoma include a large suprasellar mass that invade surrounding structures, calcification, and rarely hemorrhage.
MRI
On brain MRI, pituitary adenoma is characterized by a large mass with heterogeneous signal. Other findings may include remodeling of the floor of the sella and deviation of the pituitary infundibulum to the opposite side.
Other Imaging Studies
Historically, before the advent of MRI, the pituitary was imaged by lateral skull x-rays to look for remodelling of the pituitary fossa.[1]
Other Diagnostic Studies
Inferior petrosal sinus sampling may be performed to detecthormonally active pituitary microadenoma.
References
- ↑ Pituitary Microadenoma. Dr Amir Rezaee and Dr Frank Gaillard. Radiopaedia.org 2015. http://radiopaedia.org/articles/pituitary-microadenoma