PITUTARY TUMOURS

Convenor : Dr. R. Jalali

Working Group

Radiation Oncology
R Sarin
R Jalali
T Gupta
A Munshi

Neurosurgery
A Goel
A Chagla

Endocrinology
PS Menon
N Shah

Patholgy
SV Kane
S Sharma

Radiology
NM Merchant
SL Juvekar

Clinical Psychology
S Goswami
J Deodhar

Occupational therapy
R Kamble

PITUTARY TUMOURS

EVIDENCE BASED MANAGEMENT FOR PITUITARY ADENOMA

Pituitary adenomas are classified as functioning or non-functioning depending upon their secretory potential. They comprise nearly 10-15% of all intracranial tumours.
In the department of neurosurgery at K.E.M. hospital, on an average 135 cases of pituitary tumours are operated annually. Of these, approximately 60% cases are of non-secretory or non-functioning variety.
At TMH, we see 25-30 cases per year.
Non-functioning adenomas generally present with clinical features of a progressively growing mass lesion. Symptoms are secondary to affection of the visual apparatus, hypothalamus and cranial nerves traversing the cavernous sinus. Rarely, hemispheric symptoms and symptoms due to raised intracranial pressure may also be seen. Compromise of the normal pituitary gland usually results in moderate to severe hypopituitarism. An apoplectic haemorrhage and/or infarction into an adenoma (pituitary apoplexy) can result in acute onset symptoms from compromise of the visual apparatus. Clinical signs and symptoms in such cases generally include sudden onset headache, nausea, vomiting, diplopia, and visual impairment. Functioning adenomas are usually detected earlier when they are relatively small in size due to the nature of specific presenting symptoms and signs. Less commonly, such tumours may also grow into large size before being detected.

General Principles and Outline of Management

High degree of clinical suspicion is mandatory for early detection. Regular visual acuity and field testing of the general population may assist in early detection of these histologically benign lesions.

• Thorough clinical assessment taking particular note of the visual status, endocrine disturbances including diabetes insipidus
• Careful physical examination including
            Vision: acuity, field of vision and fundus examination, perimetry
            Cranial nerves examination particularly III, IV and VI
            Complete endocrinologic examination
• Gadolinium enhanced MRI brain
• Endocrine Evaluation
            Basal cortisol
            Thyroid function tests (T3, T4 and TSH)
            Gonadal axis evaluation (FSH and LH; and Testosterone also in males)
            Prolactin
            Growth Hormone, if clinically indicated

The hormonal investigations can be made after surgery if it is an emergency (visual compression or apoplexy). In this instance, patient may be given steroid cover (hydrocortisone 50-100 mg 8 hrly) after collection of blood for investigations.