PITUITARY ADENOMAS DR.RAVINDRA SRIVASTAVA.MCh(AIIMS)N.D. CONSULTANT NEUROSURGEON. VIMHANS,N.D.

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Presentation transcript:

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 1 st.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