PITUITARY ADENOMAS

DR.RAVINDRA SRIVASTAVA.MCh(AIIMS)N.D.

CONSULTANT NEUROSURGEON.VIMHANS,N.D

PROLACTINOMA

• PRL LEVELS GREATER THAN FIVE TIMES THE UPPER LIMIT OF NORMAL ARE USUALLY ASSOCIATED WITH PRL-SECREATING TUMOURS.

• LARGE TUMOURS>2cmASSOCIATED WITH PRL.<150ng/ml- NONSECRETORS .

• GIANT AND INVASIVE PRL.>3cm-MAY SHOW FALSE LOW PRL.due to HOOK EFFECT.

Random GH- Not useful.False positive and false negative results.

Insulin like growth factor1- BEST FOR SCREENING.

Oral glucose GH supression testing - GOLD STANDARD.- 75mg glucose load

& GH measurement at 30min. Intervals for 2 hrs. NORMAL-GH<2ng/l RIA.

MANAGEMENT.

• PROLACTINOMAS- Most pts.Are managed with medications or surgery.Bromocriptine or Cabergoline.are the 1st.line drugs.

• SURGICAL INDICATIONS- 1. Failure to tolerate medicines.or afford the cost of medicines. 2.does not want life long medications.3.Large cystic tumour. 4.Sustained tumour reduction is absent.5.Desire for fertility.(tumour expansion and optic n.compression)5. Pituitary Apoplexy.

• STRONG CONSIDERATION SHOULD BE GIVEN TO SURGERY IN PTS. WITH SMALLER WITHOUT SIGNIFICANT HYPERPRL.BECAUSE CHEMICAL CURE i.e.PRL<20ng/ml occurs postoperatively.

TEAM WORK FOR MNG.OF PIT.ADENOMAS.

• HORMONAL STATUS-ENDOCRINOLOGIST.• VISUAL FIELD/VISION- OPTHALMOLOGIST.• TUMOUR SURGERY- NEUROSURGEON.• MONITOR TUMOUR RECURRENCE-

RADIOLOGIST.• BLOOD TESTS- PATHOLOGIST

THANK YOU