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Classification of pituitary tumors 007
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Based on size, pituitary tumors can be divided into
microadenomas (<1cm diameter) and macroadenomas (>1 cm diameter). They
also can be classified on the basis of staining characteristics, as
chromophobic and chromophilic tumors. The latter can be further subdivided using
hematoxylin and
eosin stains (ie, eosinophilic or basophilic).
However, this classification has proven to be of no
clinical value and now has been replaced by a more functional classification
that involves electronmicroscopy and immunohistochemistry. These techniques
have identified hormones in many chromophobe adenomas, enabling pathologists to
identify that they are produced by eosinophilic tumors. They also have
demonstrated that many tumors produce more than one hormone. The mutated form
p53, a tumor suppressor, also can be determined histologically. This mutated
gene suggests a tumor with rapid growth.
The endocrinologic morbidity that is
associated with pituitary tumors is dependent on the specific underproduction
or overproduction of a hormone or hormones associated with the tumor(44).
Hormonal deficiencies Clinical effectsGrowth hormone deficiency
Adults - Increased rate of cardiovascular disease,
obesity, reduced muscle strength and exercise capacity, and increased
cholesterol Infants
- Hypoglycemia Children
- Decreased height and growth rate .
Gonadotrophin deficiency
Men - Diminished libido and impotence; testes shrink
in size, but spermatogenesis is generally preserved Women - Diminished libido and
dyspareunia; breast atrophy in chronic deficiency Children - Delayed or frank
absence of puberty Adolescent girls - Present similarly to adult women .Thyrotropin
deficiency - Malaise, weight gain, lack of energy, cold intolerance,
constipation .
Corticotrophin deficiency
Unlike primary adrenal insufficiency,
rnineralozortlcold function (which is dependent on the angiotensin-renin axis)
is not affected; deficiency is limited to glucocorticoids and adrenal androgens . Initially, symptoms
are nonspecific (eg, weight loss, lack of energy, malaise); severe aorenal
insufficiency may present as a medical emergency .
Panhypopituitarism - Refers to deficiency of several
anterior pituitary hormones. It may occur in a slowly progressive fashion.
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