Abdulaziz Al Taisan

207001393
 Pituitary gland.
 Pituitary adenoma.
 Classification.
 Clinical Presentation.
 Investigations.
 Treatment.
 Anterior lobe:
• Growth hormone.
• Prolactin.
• ACTH.
• TSH.
• FSH & LH.
 Posterior lobe:
• ADH.
• Oxytocin.
 Slowly progressing.
 Benign with no malignant potential.
 Etiology: unknown
 10-15% of primary brain tumors.
 70% of adenomas are endocrinogically

secreting.
 According to size:
• Microadenoma: < 10 mm.
• Macroadenoma: > 10 mm.

 According to function:
• Secretory.
• Non secretory.
 Macroadenoma.

◦ MRI, T1, post gadolinium

 Microadenoma
◦ MRI. T1
 Endocrine hypersecretion:

• Prolactin: hypogonadism, infertility, amenorrhea,

and galactorrhea.
• Growth hormone: Gigantism and acromegaly.
• ACTH: Cushing’s disease.
• TSH: Hyperthyroidism.
• FSH & LH: rarely: testicular enlargement and ovarian
hyperstimulation.
 Endocrine Hyposecretion:

• 25-30% of adenomas.
• Could be:
• Panhypopituitarism.
• Growth hormone.
• FSH & LH
 Mass effect:

• Visual deficits: Bitemporal hemianopia

• Headache.
• Elevated intracranial pressure
 Visual field assessment.
 Endocrine evaluation.
 X-ray.
 CT
 MRI.
 Enlarged sella and focal calcification in the adenoma
 MRI, T1
 Medical:
 Bromocriptine: dopamine agonist, reduces tumor size.
 Somatostatin: GHIH.
 Radiation therapy.
 Surgery.
 Transsphenoidal approach.
 Subfrontal approach.
 Transcavernous approach.
 Transsphenoidal approach:
 The most common approach.
 Effective in tumors extending inferiorly.
 There is limited accessibility in the other directions.
 Subfrontal approach:
 Allows improved visualization of the
optic nerves, chiasm and surrounding
brain structures.
 The most common indication for this approach
is progressive visual loss.
 Transcavernous approach:
 Invasion of cavernous sinuses.
 A frontotemporal craniotomy.