1. Step 9
1.1. Review session 2
1.2. mechanism flow chart
1.2.1. tumor gets bigger affecting the anterior pitatury
1.3. 20 minutes
2. Step 10
2.1. Management
2.1.1. goals of managment
2.1.1.1. restore normal function by restoring normal hormonal levels
2.1.1.1.1. restore normal growth of the patient
2.1.1.2. releave visual symptoms
2.1.1.3. releave associated symptoms
2.1.1.4. improve quality of life
2.1.1.5. psychosocial approach
2.1.1.5.1. for the learning difficulties
2.1.1.5.2. bullying problem
2.1.1.6. prevent recurrence
2.1.2. surgeries
2.1.2.1. transsphenoidal surgery
2.1.2.1.1. microscopic surgery to resect the tumor
2.1.2.1.2. not preferred to do it when the tumor is very large and involve nerves
2.1.2.1.3. complication such as infection, nasal deformaties or bleeding, pituitary may be dystroied which leads to diabetes, may affect the meninges
2.1.2.2. craniotomy
2.1.2.2.1. more invasive and associated with more complications
2.1.2.2.2. can lead to frontal lobe damage
2.1.2.3. first thing is to confirm the type of the tumor
2.1.2.4. when the optic chiasm is involved the sooner u do it the better
2.1.2.5. contraindications
2.1.2.5.1. respiratory or cardiac problems
2.1.2.5.2. patients taking anti coagulations
2.1.2.6. after the surgery they might need replacement therapy
2.1.2.7. replacement before the surgery for the TSH because it can leads to respiratory problem after the opioid
2.1.2.8. follow up every week for 1-2 week .. then every 3 months for a year
2.1.2.9. MRI should be performed one week after the surgery .. then it is best to do it from 3-6 months after the surgery
2.1.2.10. transsphenoidal surgery
2.1.3. radiation
2.1.3.1. 3 weeks after surgery for candidate patients
2.1.3.2. external peam radiation
2.1.3.2.1. it may damage the normal tissue of the body
2.1.3.3. the gamma stereotactic radiosurgery
2.1.3.3.1. it does not affect the normal tissue
2.1.3.3.2. cannot do it when there is nerve involved
2.1.3.4. it can be primary or secondary
2.1.3.5. also it is used in recurrence prevention
2.1.4. replacement therapy
2.1.4.1. can reduce long term morbidity
2.1.4.2. it cannot be given alone .. the tumor should be removed unless it is prolactenoma ( dopamine agonist is given to shrink the tumor)
2.1.4.3. hormones deficient
2.1.4.3.1. GH
2.1.4.3.2. TSH
2.1.4.3.3. ACTH
2.1.4.3.4. LH and FSH