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Tumori hipofizare
Definitie Clasificare histopatologica si neuroradiologica Tablou clinic Investigaii
Hormonologie Imagistic
Diagnostic pozitiv si diferential Etiologie si patogenie Anatomie patologica Fiziopatologie Evolutie, complicatii Tratamentul tumorilor hipofizare
Obiective: etiologic, fiziopatologic, substitutiv Mijloace terapeutice Urmrirea eficienei terapiei
Concluzii
Corin Badiu, 2010
Tumori hipofizare
Definitie: Adenoame hipofizare benigne, clinic secretante
/nesecretante, intraselare /cu extensie supraselara, rareori ADK hipofizare, insotite de complicatii endocrine (hipopituitarism, diabet zaharat), neurologice sau oftalmologice.
Clasificare
Histologic (MO): cromofobe - 70%, PRL 50% acidofile 15%, GH si PRL bazofile 15%, ACTH Adenoame secretante: 20% GH acromegalie 35% PRL prolactinom 7% GH + PRL 7% ACTH + MSH boala Cushing si sd Nelson 20% LH, FSH, TSH Adenoame nesecretante: 10% cu celule foliculostelate, oncocitom
Clasificare
Clasificare neuroradiologica
Hardy: Stadiul I microadenom, < 10 mm II macroadenom, cu expasiune III invaziv localizat IV invaziv difuz
Tablou clinic
Sindrom endocrin: Acromegalie/ gigantism; sd amenoree-galactoree; Cushing; Melanodermie; Hipopituitarism Sindrom neurologic: Sd Neurooftalmic Leziuni n cranieni III, IV, VI HIC (cefalee, varsaturi, edem papilar) Rinoliquoree Epilepsie temporala
Tablou clinic
Sindrom endocrin: Acromegalie/ gigantism; sd amenoree-galactoree; Cushing; Melanodermie; Hipopituitarism
Acromegaly: Outside
Without Acromegaly
Normal blood pressure Normal breathing patterns Normal sleep pattern
With Acromegaly
Increased risk of cardiovascular disease Respiratory conditions and intrinsic lung disease Sleep apnea
Acromegaly: Outside
Sindrom tumoral
Paraclinic - Imagistic
Radiografia de sa turca
Paraclinic - Imagistic
Tomografia computerizata
Prolactinom invaziv
Craniofarigiom
IRM normal
Lechan RM. Neuroendocrinology of Pituitary Hormone Regulation. Endocrinology and Metabolism Clinics 16:475-501, 1987
IRM normal
Paraclinic - Imagistic
IRM
Craniofaringiom
Metastaze hipofizare
Paraclinic - Imunoassay
Teste bazale si dinamice: exces- supresie; deficit clinic- inhibitie GH OGTT 0, 30, 60, 90, 120 min (ACM) : 1 ng/ml PRL 20 ng/ml 100 ng/ml 10000 ng/ml
Reacia antigen-anticorp
Ag + Ac* Ag Ac*
Corin Badiu, 2010
Ag voluminos
Ac. de captura
Ac. de semnal
Corin Badiu, 2010
Circadian Rhythm in Plasma ACTH and Cortisol in a Clinically Healthy Adult Women Sampled at 20 minute Intervals
Plasma ACTH
6.6
Plasma Cortisol
828
* * * *** * * *
* *
* *
ACTH (mU/L)
Cortisol (mU/L)
* * * * * * * * *
00:00 04:00
12:00
16:00
20:00
00:00
04:00
08:00
12:00
12:00
16:00
20:00
08:00
12:00
Diagnostic diferential
Sa turca larga
constitutional, LCR, vase (anevrism de carotida, sunturi intercavernoase), chist dermoid, arahnoidian, tumori- gliom optic
Melanodermie
Sd Cushing si sd Cushingoide Insuficiente primare: gonade, mixedem, Addison
Diagnostic diferential
Sa turca larga Acromegalie
Heaney & Melmed, Endocrine related cancer, 7, 2000 2010 Corin Badiu,
Anatomie patologica
NFA, TSH & FSH IR
TSH - ICC
FSH ICC
Corin Badiu, 2010
Fiziopatologie
Hormon excesiv/ deficitar
Complicatii:
Tratament
Obiective: distrugerea celulelor tumorale, blocarea
secretiei autonome, pastrarea functiei
Principii: dg detaliat Metode: expectativa (incidentalom), chimioterapie specifica, chirurgia hipofizei, radioterapie
Tratament etiologic
Chimioterapie specifica
Agonisti Dopaminergici: Bromocriptina, Cabergolina Agonisti Somatostatinergici (SMSa) Lanreotide, Octreotide Dopastatine Analogi GH (Pegvisomant)
Tratament substitutiv
Principii:
Ordinea (axa vitala!) Administram Hh. gl. inta Rata secreiei, ritm
CSR Cortizon acetat (20-30 mg) sau Pdn, alternnd cu ACTHa (+ sinteza Androgeni, Cortizol i trofic) Tiroidian (T4, T3, 100 mg/zi); rhTSH (n KK tir) Gonadic: (E2/Pg); Fertilitate: (FSHa, LHa) diferit la fa de GH (opional, costuri)
Corin Badiu, 2010
CONCLUZII
Evaluare imagistica de inalta rezolutie Evaluarea bazala, dinamica in inhibiie sau stimulare Integrarea rezultatelor clinice, biochimice, imagistice. Tratament specific, selectiv