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14-September-2008 18:02:48 - adenoma Pituitary adenoma Classification and external resources ICD-10 D35.2 ICD-9 237.0 ICD-O: M8140/0 MedlinePlus 000704 eMedicine neuro/312 MeSH D010911 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 have an estimated prevalence of 16.7% 14.4% in autopsy studies and 22.5% in radiologic studies.12 Contents 1 Types 2 Diagnosis 3 Treatment 4 Additional images 5 References 6 External links Types Pituitary tumors were, historically, classed as basophilic, acidophilic, or chromophobic on the basis of whether or not they took up the stains hematoxylin and eosin. This classification has fallen into disuse, in favor of a classification based on what type of hormone is secreted by the tumor though tumors which do not secrete any active hormone non-functioning tumors are still sometimes called chromophobic. At present, classification of pituitary tumors is based on plasma hormone levels or immunohistochemical staining: Type of adenoma Secretion Staining Pathology corticotrophic adenomas secrete adrenocorticotropic hormone ACTH and pro-opiomelanocortin POMC basophilic Cushing's disease somatotrophic adenomas secrete growth hormone GH acidophilic acromegaly gigantism thyrotrophic adenomas rare secrete thyroid-stimulating hormone TSH basophilic occasionally hyperthyroidism3, usually doesn't cause symptoms gonadotrophic adenomas secrete luteinizing hormone LH, follicle-stimulating hormone FSH and their subunits basophilic usually doesn't cause symptoms lactrotrophic adenomas or prolactinomas most common secrete prolactin acidophilic galactorrhea, hypogonadism, amenorrhea, infertility, and impotence null cell adenomas do not secrete hormones may stain positive for synaptophysin Diagnosis The diagnosis is generally entertained either on the basis of visual difficulties arising from the compression of the optic nerve by the tumor, or on the basis of manifestations of excess hormone secretion: the specifics depend on the type of hormone. The specific area of the visual pathway at which compression by these tumours occurs is at the optic chiasma. The anatomy of this structure causes pressure on it to produce a defect in the temporal visual field on both sides, a condition called bitemporal hemianopia. Tumors which cause visual difficulty are likely to be macroadenomata greater than 10 mm in diameter; tumors less than 10 mm are microadenomata. Some tumors secrete more than one hormone, the most common combination being GH and prolactin. Prolactinomas are frequently diagnosed during pregnancy, when the hormone progesterone increases the tumor's growth rate. Headaches may be present. The diagnosis is confirmed by testing hormone levels, and by radiographic imaging of the pituitary for example, by CT scan or MRI. Treatment Treatment options depend on the type of tumor and on its size: Prolactinomas are most often treated with bromocriptine or more recently, cabergoline which, unlike bromocriptine, decreases tumor size as well as alleviates symptoms, both dopamine agonists, and followed by serial imaging to detect any increase in size. Treatment where the tumor is large can be with radiation therapy or surgery, and patients generally respond well. Efforts have been made to use a progesterone antagonist for the treatment of prolactinomas, but so far have not proved successful. Thyrotrophic adenomas respond to octreotide, a long-acting somatostatin analog, in many but not all cases according to a review of the medical literature. Unlike prolactinomas, thyrotrophic adenomas characteristically respond poorly to dopamine agonist treatment.3 Additional images References ^ Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, McCutcheon IE. August 2004. The prevalence of pituitary adenomas: a systematic review. Cancer 101 3: 613-9. doi:10.1002/cncr.20412. PMID 15274075. Retrieved on 2008-09-03. ^ Asa SL August 2008. Practical pituitary pathology: what does the pathologist need to know?. Arch. Pathol. Lab. Med. 132 8: 1231-40. PMID 18684022. Retrieved on 2008-09-03. ^ a b Chanson P, Weintraub BD, Harris AG August 1993. Octreotide therapy for thyroid-stimulating hormone-secreting pituitary adenomas. A follow-up of 52 patients. Ann. Intern. Med. 119 3: 236-40. PMID 8323093. Retrieved on 2008-09-03. External links Cancer.gov: pituitary tumors Case report of Bilateral Hemianopsia Due to Pituitary Adenoma. Clinical Cases and Images. Medical Illustration of Pituitary Adenomas by Frank H. Netter v d e Tumors: endocrine gland neoplasia C73-C75/D34-D35, 193-194/226-227 Pancreas/ islets of Langerhans neuroendocrine tumors/islet cell carcinoma: α:Glucagonoma - β:Insulinoma - δ:Somatostatinoma - Gastrinoma - VIPoma Pituitary Prolactinoma - ACTH-secreting pituitary adenoma - Growth hormone-secreting pituitary adenoma Thyroid Papillary - Follicular/Hurthle cell - Medullary - Anaplastic - Thyroid adenoma Parathyroid Parathyroid adenoma - Parathyroid carcinoma Adrenal tumor adrenal cortex Adrenocortical adenoma, Adrenocortical carcinoma - adrenal medulla Pheochromocytoma, Neuroblastoma - see also Paraganglioma Other Pineal - Multiple endocrine neoplasia 1, 2 see also disorders Retrieved from http://en..org/wiki/Pituitary_adenoma Categories: Neuroendocrinology | Types of cancer Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages ÄŒesky Deutsch Nederlands SlovenÄ?ina Svenska This page was last modified on 3 September 2008, at 15:37
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