LOCAL MASS EFFECT Headache
Occurs in most patients with enlargement of the pituitary fossa. It is not specific in site or nature.
Pressure on the inferior aspect of the optic chiasma usually causes superior temporal quadrantanopia initially, with progression to bitemporal hemianopia, but any pattern can occur.
IV nerve nerve nerve
IV nerve nerve
Cavernous sinus compression
Carotid — artery
VI nerve ^
The clinical syndrome produced is dependent on the hormone secreted.
Growth hormone (GH)
Stimulates growth and plays a part in control of protein, fat and carbohydrate metabolism. Excess GH
in the adult causes ACROMEGALY. -
In childhood, prior to fusion of bone epiphyses, GH excess causes GIGANTISM. GH levels are usually increased to > 10 mU/1. Increased serum levels of insulin growth factor-1 enhances the effect of growth hormone on target organs.
Hyperglycaemia normally suppresses GH secretion. GH samples are taken in conjunction with blood glucose during a glucose tolerance test. The lack of GH suppression after glucose administration confirms the presence of a tumour.
In some pituitary tumours, lateral expansion may compress nerves lying within the walls of the cavernous sinus. The III nerve is especially vulnerable. Rarely vertical expansion obstructs the foramen of Munro causing hydrocephalus and/or hypothalamic compression (page 334).
Enlargement of soft tissues, cartilage and bones in face, hands and feet
Enlarged finger • pulps and heel pads.
Enlarged viscera -heart, liver, thyroid.
Diabetes occurs in 10%
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