Pituitary Gland disorders

The correct options are Answer: b, c


Patients with pituitary lesions present symptoms and signs related to a mass effect on the pituitary and its surrounding structures, to hypersecretion of the hormones by the lesion itself, or to a combination of both. As mass lesions in the pituitary enlarge, they encounter the various contents of the cavernous sinuses, including the third, fourth, sixth and first two divisions of the fifth cranial nerves, as well as the internal carotid artery. The growth of a tumor in the relatively unrestricted upward direction is much more common and often results in compression of the optic chiasm with the resultant loss of vision, typically a bitemporal hemianopsia. Prolactin-secreting pituitary adenomas often present with endocrine symptoms including amenorrhea and galactorrhea in women. In men, the loss of libido, infertility and visual loss are typical. Magnetic resonance imaging (MRI) has evolved as the first choice for diagnostic imaging and is often the only tool needed to reach a therapeutic decision with regard to pituitary adenomas. With intravenous infusion of a paramagnetic substance such as gadolinium, MRI demonstrates intrasellar tumors as small as 5 mm. In addition, the extent of suprasellar and sphenoid sinus extension, as well as lateral extension into the cavernous sinuses, is demonstrable. Cysts and hemorrhage can be differentiated, as can blood flowing within an aneurysm. CT scanning has a place in pituitary imaging if MRI scanning is unavailable. Plain skull X-rays are not needed generally. Cerebral angiography is performed only if an aneurysm is suspected or if a lesion is so large that occlusion or compression of the internal carotid artery is in question. For this patient, the symptoms clearly point to a central nervous system, pituitary etiology rather than abdominal end organ failure with regard to the amenorrhea.

Category: