Sellarsuprasellar tumours pituitary adenoma

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LOCAL MASS EFFECT Headache

Occurs in most patients with enlargement of the pituitary fossa. It is not specific in site or nature.

Visual field defects

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.

nerve

IV nerve nerve nerve

IV nerve nerve

Cavernous sinus compression

Cavernous sinus

Carotid — artery

VI nerve ^

Sphenoid sinus

ENDOCRINE EFFECT

1. HYPERSECRETION

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

Coarse skin

Enlarged finger • pulps and heel pads.

Enlarged viscera -heart, liver, thyroid.

Diabetes occurs in 10%

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