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NEUROLOGY ASPECT OF PITUITARY TUMORS

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Anwar Wardy W

Pituitary Tumors(Hypophyse; 10%

ICT)

• NONFUNCTIONING ADENOMAS

• FUNCTIONING ADENOMAS

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Anwar Wardy W

NONFUNCTIONING ADENOMAS

Nonfunctional pituitary adenomas present in general as a consequence of local mass effect. Patients often initially present to their primary physicians with complaints of headache, vomiting, drowsiness from irritation of the duramater and intracranial pressure or fatigue from panhypopituitarism,

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If the tumor extends to involve the optic chiasm, they will present with varying degrees of visual loss. The classic presentation of the visual deficit is a bitemporal hemianopsia, but central scotomas and generalized blurring of vision are sometimes the complaint.

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Panhypopituitarism as a consequence of mass effect on the normal pituitary gland can result in fatigue and sexual dysfunction ranging from decreased libido to lack of erectile function, and often requires direct questioning of the patient to elicit.

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FUNCTIONING ADENOMAS

• Hyperfunctioning pituitary tumors arise from neoplastic transformation of secretory hormone cells and present with syndromes associated with excess production of their respective hormone. These syndromes include growth hormone excess resulting in the classic presentation of acromegaly in adults and gigantism in children, ACTH hypersecretion resulting in Cushing's disease, and hyperprolactinemia from prolactin adenomas.

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Functions of the pituitary gland:

Each lobe of the pituitary gland produces certain hormones • anterior lobe:• growth hormone • prolactin - to stimulate milk production after giving birth • ACTH (adrenocorticotropic hormone) - to stimulate the adrenal

glands • TSH (thyroid-stimulating hormone) - to stimulate the thyroid

gland • FSH (follicle-stimulating hormone) - to stimulate the ovaries

and testes • LH (luteinizing hormone) - to stimulate the ovaries or testes• intermediate lobe:• melanocyte-stimulating hormone - to control skin pigmentation • posterior lobe:• ADH (antidiuretic hormone) - to increase absorption of water

into the bloodby the kidneys

• oxytocin - to contract the uterus during childbirth and stimulate milk production

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• Hormone Major target organ(s)Major Physiologic Effects

Anterior Pituitary• Growth hormone: Liver, adipose tissue Promotes growth

(indirectly), control of protein, lipid and carbohydrate metabolism

• Thyroid-stimulating hormone: Thyroid gland; Stimulates secretion of thyroid hormones

• Adrenocorticotropic hormone:Adrenal gland (cortex); Stimulates secretion of glucocorticoids

• Prolactin: Mammary gland; Milk production• Luteinizing hormone: Ovary and testis; Control of

reproductive function • Follicle-stimulating hormone:Ovary and testis; Control

of reproductive function Posterior Pituitary• Antidiuretic hormone:Kidney Conservation of body

water• Oxytocin:Ovary and testis Stimulates milk ejection and

uterine contractions

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Dihasilkan Posterior Lobe:

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Pituitary adenoma

• 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.

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Non-Functioning Adenoma

• Mass Effect :1. Null cell adenoma

2. Oncoytomas

3. Gonadotropin-secreting adenomas

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Dihasilkan Posterior Lobe:

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Dihasilkan Anterior Lobe:

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Functional Adenoma • Mass Effect :1. Prolactinoma in males 2. Nelson's syndrome 3. TSH-adenoma (setting of thyroid ablation)

• Endocrinopathy :1. Prolactinomas in females 2. TSH-adenoma 3. Cushing's Disease 4. Acromegaly/Gigantism

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Anwar Wardy W

Anwar Wardy W

Effects of pituitary tumors

• Production of excessive amounts of pituitary hormone(s)

• Progressive decline of other pituitary secretions from normal pituitary cells (both macro and microadenomas)

• Pituitary stalk compression leading to reduced dopamine inhibition of prolactin secretion, thereby resulting in elevated prolactin levels

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Local effects of enlarging pituitary tumors include:

– Headaches – Progressive deterioration of visual fields due to

optic nerve chiasm compression associated with superior tumor expansion.

– Cranial nerve damage through extension into the cavernous sinuses

– Erosion of the pituitary fossa, into the sphenoid sinus, leading to leakage of CSF (rhinorrea) through the nose.

– Occlusion of normal CSF flow due to blocked pathway by tumor mass

– Very rarely, the enlarging tumor may spread into local brain tissue

Anwar Wardy W

Anwar Wardy W

Anwar Wardy W

Thank You

Wassalam, Wr, Wbr