Pathology: Monoclonal tumours with tumour activity depending on cell type
Comatotrophs-Increased Growth hormone secretion
Thyrotrophs-Increased TSH Secretion
Gonadotrophs-Increased FSH/LH secretion.
Aetiology: Mutations in oncogenes: Gsα (~40% of GH-secreting tumours) and
Ras (aggressive tumours)
Multiple Endocrine Neoplasia: Type 1
Symptoms: Headache(typically worse on waking), fatigue, myalgia, double vision, nasal congestion
Signs: Bi-temporalhemianopia, CSF rhinorrhoea, signs of raised ICP, cranial nerve palsy of nervesIII, IV and VI within the cavernous sinus.
Investigations: Bloods: Pituitaryprofile. Likely to need Dynamic EndocrineTesting.
Special tests: Humphrey’s fieldtest
Imaging: MRI pituitary
Treatment: Medical: Hormone replacement as required and radiotherapy issurgery not
Complications: Apoplexy (bleed into pre-existingtumour), hypopituitarism
Prognosis: Good where tumour fully resectedand no hormone pathology.
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