Pathology:                    Monoclonal tumours with tumour activity depending on cell type

                                          Corticotrophs-Cushing’s Disease

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


Surgical: Trans-sphenoidalsurgery


Complications:          Apoplexy (bleed into pre-existingtumour), hypopituitarism


Prognosis:                    Good where tumour fully resectedand no hormone pathology.








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