A 30-year-old male complains of loss of erection; he has low testosterone and high prolactin level in blood;
What is the likely diagnosis: (AIIMS Nov 2010)
Pituitary tumours (almost always benign adenomas) account for 10% of intracranial tumours. They may be divided by size: a microadenoma is a tumour< 1cm, and a macroadenoma is > 1cm.
Symptoms are caused by local pressure, hormone hyper secretion, or hypopituitarism
Features of local pressure (Especially if size is more than 10 mm)
2). visual field defects (bilateral temporal hemianopia, due to compression of the optic chiasma),
3). palsy of cranial nerves III,IV, VI (pressure or invasion of the cavernous sinus).
4). Diabetes insipidus (DI) more likely from hypothalamic disease); disturbance of hypothalamic
5). centres sleep, and appetite; erosion through floor of sella leading to CSF rhinorrhea.
Treatment of hypopituitarism
1). In hypopituitarism start hormone replacement as needed. Ensure steroids are given before thyroxine, as thyroxine may precipitate an adrenal crisis.
2). Surgery: pituitary surgery is trans-sphenoidal
3). Radiotherapy: Post-op if complete removal of the tumour has not been possible.