NEUROLOGY ASPECT

OF PITUITARY TUMORS

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Pituitary Tumors
(Hypophyse; 10%
ICT)
NONFUNCTIONING ADENOMAS
FUNCTIONING ADENOMAS
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NONFUNCTIONING ADENOMAS
Nonfunctional pituitary
adenomas present in general as a
consequence of local mass effect.
Patients often initially present to
their primary physicians with
complaints of headache, vomiting,
drowsiness from irritation of the
duramater and intracranial
pressure or fatigue from
panhypopituitarism,
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If the tumor extends to involve

the optic chiasm, they will
present with varying degrees of
visual loss. The classic
presentation of the visual deficit
is a bitemporal hemianopsia, but
central scotomas and generalized
blurring of vision are sometimes
the complaint.
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Panhypopituitarism
as
a
consequence of mass effect on
the normal pituitary gland can
result in fatigue and sexual
dysfunction
ranging
from
decreased libido to lack of
erectile function, and often
requires direct questioning of the
patient to elicit.
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FUNCTIONING ADENOMAS
Hyperfunctioning pituitary tumors arise
from neoplastic transformation of
secretory hormone cells and present with
syndromes associated with excess
production of their respective hormone.
These syndromes include growth
hormone excess resulting in the classic
presentation of acromegaly in adults and
gigantism in children, ACTH
hypersecretion resulting in Cushing's
disease, and hyperprolactinemia from
prolactin adenomas.
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Functions of the pituitary gland:

Each lobe of the pituitary gland produces certain hormones

anterior lobe:
growth hormone
prolactin - to stimulate milk production after giving birth
ACTH (adrenocorticotropic hormone) - to stimulate the adrenal
glands
TSH (thyroid-stimulating hormone) - to stimulate the thyroid
gland
FSH (follicle-stimulating hormone) - to stimulate the ovaries and
testes
LH (luteinizing hormone) - to stimulate the ovaries or testes
intermediate lobe:
melanocyte-stimulating hormone - to control skin pigmentation
posterior lobe:
ADH (antidiuretic hormone) - to increase absorption of water
into the blood
by the kidneys
oxytocin - to contract the uterus during childbirth and stimulate
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milk production

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 Hormone Major target organ(s)Major

Physiologic Effects
Anterior Pituitary
Growth hormone: Liver, adipose tissue Promotes growth
(indirectly), control of protein, lipid and carbohydrate
metabolism
Thyroid-stimulating hormone: Thyroid gland;
Stimulates secretion of thyroid hormones
Adrenocorticotropic hormone:Adrenal gland (cortex);
Stimulates secretion of glucocorticoids
Prolactin: Mammary gland; Milk production
Luteinizing hormone: Ovary and testis; Control of
reproductive function
Follicle-stimulating hormone:Ovary and testis; Control
of reproductive function
Posterior Pituitary
Antidiuretic hormone:Kidney Conservation of body
water
Oxytocin:Ovary and testis Stimulates milk ejection and
uterine contractions
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Dihasilkan Posterior Lobe:

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Pituitary adenoma
Pituitary adenomas are tumors
that occur in the pituitary gland,
and account for about 10% of
intracranial neoplasms. They often
remain undiagnosed, and small
pituitary tumors are found in 6 to
24 percent of adults at autopsy.
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Non-Functioning
Adenoma
Mass Effect :
1. Null cell adenoma
2. Oncoytomas
3. Gonadotropin-secreting adenomas

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Dihasilkan Posterior Lobe:

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Dihasilkan Anterior Lobe:

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Functional Adenoma

Mass Effect :

1. Prolactinoma in males
2. Nelson's syndrome
3. TSH-adenoma (setting of thyroid ablation)
Endocrinopathy :
1. Prolactinomas in females
2. TSH-adenoma
3. Cushing's Disease
4. Acromegaly/Gigantism
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Effects of pituitary tumors

Production of excessive amounts of
pituitary hormone(s)
Progressive decline of other pituitary
secretions from normal pituitary cells (both
macro and microadenomas)
Pituitary stalk compression leading to
reduced dopamine inhibition of prolactin
secretion, thereby resulting in elevated
prolactin levels
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Local effects of enlarging

pituitary tumors include:
Headaches
Progressive deterioration of visual fields due to
optic nerve chiasm compression associated with
superior tumor expansion.
Cranial nerve damage through extension into the
cavernous sinuses
Erosion of the pituitary fossa, into the sphenoid
sinus, leading to leakage of CSF (rhinorrea)
through the nose.
Occlusion of normal CSF flow due to blocked
pathway by tumor mass
Very rarely, the enlarging tumor may spread into
local brain tissue
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Thank You
Wassalam, Wr, Wbr

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