Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

1176 Pituitary Tumors

■Hypothalamic mass: craniopharyngioma, dysgerminoma

■Metastatic tumor: breast and lung most common

■Granulomatous disease and histiocytosis: may cause anterior and

posterior pituitary deficiency 10% of people have small microade-

nomas that are nonsecretory. Clinically silent tumors may be found

when patient has MRI for other causes (“incidentaloma”).

management

What to Do First

■Determine hormone deficiencies (partial or panhypopituitarism)

and excesses

■Assess size and resectability of tumor

■Rule out apoplexy

■Obtain tissue for diagnosis if possible

Treatment Goals

■Treat hormone deficiencies and excesses

■Resect or diminish size of pituitary or CNS mass

specific therapy

■Hormone replacement therapy:

➣Cortisol

➣Thyroid hormone

➣Testosterone

➣Estrogen/progestin

➣DDAVP

➣Growth hormone

➣Gonadotropins for fertility only

■Normalize prolactin, ACTH, or GH hypersecretion

■Surgical resection of tumor

■Medical therapy for prolactinoma and acromegaly

■Radiation therapy

■Treat granulomatous diseases

■Observation with repeated pituitary MRI to determine if tumor grow-

ing

■Side Effects & Contraindications

➣Surgery and radiation: panhypopituitarism, CNS injury

follow-up

■Assess adequacy of hormone replacement therapy annually

■Repeat pituitary MRI in 3–6 mo to assess tumor growth