Pituitary tumours account for 10% of all intracranial tumours. They are readily identified nowadays as incidental findings while patients are scanned for unrelated conditions.
These tumours become symptomatic if they are hormone secreting (microadenomas) or when they increase significantly in size to cause compressive symptoms (macroadenomas). The most commonly affected cranial nerve is the Optic (CN II), as its chiasm is situated just above the Pituitary gland. These patients typically complain of “tunnel vision” or temporal hemianopia but other patterns of visual disturbance are also common.
All patients should be seen in a multidisciplinary setting consisting of the following specialties:
· Endocrinologist – screening and after care of patient’s hormonal status
· Ophthalmologist – screening of patient’s vision pre and post-operatively
· Ear, Nose & Throat Endoscopic Anterior Skull Base Surgeon – main operating surgeon
· Neurosurgeon – for larger tumours with intracranial extension
The investigations include routine blood assays, full hormonal profile as well as accurate assessment for any visual field defect. Both CT and MRI are necessary for planning the surgery.
Some specific types of microadenomas respond well to medical treatments and these should be tried first. The remaining symptomatic tumours are treated surgically with a purely Endoscopic Trans-nasal Trans-sphenoidal approach. This has evolved since 1990s and replaced the use of the microscope as it has lower morbidity and mortality and better tumour resection results.
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