Tumors of the Adenohypophysis

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Adenomas arising in the anterior lobe of the pituitary gland constitute 10% to 15% of all intracranial tumors. Approximately two-thirds of pituitary adenomas secrete hormones, and the remaining one-third are hormonally inactive (null-cell adenomas). The tumors grow slowly, occur chiefly in adults between 30 and 60 years of age, and are more common in women than men. Endocrine symptoms due to hormonal overproduction stand in the foreground of the clinical picture and provide the basis for classification. The endocrine activities of the various adenomas and their corresponding clinical manifestations are listed in Table 11.7. Additional characteristic symptoms and signs result from compression or invasion of the adjacent structures and include headaches, bitemporal hemianopsia, hypothalamic dysfunction, cavernous sinus syndrome, hydrocephalus, and pituitary hypofunction. Enzyme assays and MRI make possible the early diagnosis of these tumors before they reach a size large enough to erode the sella, compress the chiasma, and destroy the pituitary gland.

Tumors of the Pituitary Gland

Hormones secreted by anterior pituitary adenomas Prolactin: F: Amenorrhea Galactorrhea M: Hypogonadism Growth hormone: acromegaly ACTH: Cushing syndrome TSH: Pituitary hyperthyroidism

Neurohypophysis Astrocytoma Granular cell tumor

Pituitary apoplexy due to a hemorrhagic infarction is a serious complication in about 1% to 2% of adenomas. It may be the first manifestation of the tumor, presenting acutely with headache, visual impairment, oculomotor palsy, and altered mentation.

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