PROBLEM 3: Pituitary Adenoma

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PROBLEM 3: Pituitary Adenoma by Mind Map: PROBLEM 3: Pituitary Adenoma


2. Physical examination

2.1. Inspection

2.1.1. Fatigue or lethargy

2.1.2. Weight gain or loss

2.1.3. Dizziness

2.2. Face and neck

2.2.1. Face Cushing syndrome Moon facies Acne&Hirsutism Hypothyrodism Thinning of hair or eyebrows Acromegaly Prognathism

2.2.2. eyes Periorbital puffiness (Hypothyroidism) Graves disease Exophthalmos Lid retraction+ Lid rag

2.2.3. Mouth Hypocortisolism Pigmentation on buccal surfaces Acromegaly Tongue enlargement

2.2.4. Neck Cushing's syndrome Buffalo hump Diabetes Mellitus Hyperpigmentation in the neck or axillae

2.3. Chest and abdomen

2.3.1. Chest Panhypopituitarism Reduced female breast size Adenomas (Hyper) Milk production Cushing's syndrome Male gynecomastia Central obesity Hyperthyroidism o Loud snapping first heart sounds in hyperthyroidism o Flow murmurs in hyperthyroidism

2.4. Lower limbs

2.4.1. Skin temperature

2.4.2. Color

2.4.3. Hair distribution

2.5. Special tests

2.5.1. Ophthalmic Examination

2.5.2. Neurological Examination

3. Clinical Features

3.1. Manifest as

3.1.1. Syndrome of Hyper/Hypo- secretion Such as Acromegaly

3.1.2. Neurological Manifestations Could Be Visual Field Defect Decreased Visual Acuity

3.1.3. Incidental Finding Due To Increased Usage of Sensitive Scans

4. Physiology

4.1. Covered

4.1.1. Growth Hormone Causes Increased Growth Fat Utilization Protein Anabolism Decreased Glucose Uptake Produces Somatomedins Regulated By - Hyperglycemia - Protein (Chronic) Feedback

4.1.2. Anti-diuretic Hormone Responds To Increased Serum Osmolarity Decreased ECF Volume

5. Management of Pituitary Adenoma

5.1. Pharmacotherapy

5.1.1. Classes Somatostatin Analogues GHR Antagonist Dopamine Agonists

5.2. Radiological

5.2.1. Divide into Stereotactic RadioSurgery (SRS) Delivery Fractionated Radiation Therapy (SRT) Delivery

5.2.2. Choice depend on Convenience Safety Therapeutic response

5.3. Surgical

5.3.1. Trans-Sphenoidal Surgery

6. Pituitary conditions

6.1. classified into

6.1.1. Anterior pituitary Adenomas Functional adenoma Non functional Hypopituitarism

6.1.2. Posterior pituitary could be Diabetes insipidus

7. Anatomy

7.1. includes

7.1.1. Pituitary gland is a Master gland Circumventricular organ

7.1.2. anatomical relation such as anteriorly posteriorly superiorly inferiorly laterally

7.1.3. consist of anterior lobe can be divided into posterior lobe can be divided into

7.1.4. develops from anterior lobe Rathke's pouch posterior lobe forebrain

8. Investigations

8.1. include

8.1.1. test pituitary hormones levels Hyperpituitarism may indicate hypopituitarism may indicate

8.1.2. hormones secreted by glands stimulated by pituitary

8.1.3. stimulation or suppression test

8.1.4. Imaging MRI CT