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What happens next?

After diagnosis

The Multidisciplinary team

Questions

What are the hormones doing?

What does the scan show?

What do the eye tests show?

What are we trying to achieve for the patient?

How can we best achieve it?

What are the hormones doing?

Too little? Cortisol

Thyroid

Growth hormone

Fertility hormones

Too much? Prolactinoma

Cushing’s

Acromegaly

What does the scan show?

Can often decide diagnosis on basis of a scan

MRI usually best

CT will often do

Most are benign tumours of pituitary gland

Some

developmental abnormalities

Rathke’s cleft cyst

Craniopharyngioma

covering of the brain

meningiomas

Inflammation/Infection

Other tumours

Scan

Meningioma Craniopharyngioma

Rathke’s cleft cyst

Adenoma

What do the eye tests show?

Visual fields

What are we trying to achieve?

Improvement in vision

Eyesight

Double vision

Reduction of high hormone levels

Cushings

Acromegaly

Prolactinomas

Confirmation of diagnosis

Incidental finding

How are we going to achieve it?

Medical treatment

Replacement medication

Treatment of excess hormones

Tablets/injections

Surgery

Radiotherapy

Combination of the above

The surgeon’s

perspective

How am I going to get there?

Through the nose – transphenoidal Almost all adenomas

Most Rathke’s cleft cysts

Most craniopharyngiomas

Biopsy Inflammation/Infections

Uncertain

Through the head – craniotomy Large complicated adenomas

Some craniopharyngiomas

Meningiomas

Tricks of the trade

Microscope/Endoscope

Navigation

Interventional MRI

Practicalities

5 day in-patient stay

6 week recovery

Out-patient review at

10 days

6 weeks

3 months

Monitoring

Hormones

Vision

Scan appearances

Long term follow-up

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