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What happens next?
After diagnosis
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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?
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What are the hormones doing?
Too little? Cortisol
Thyroid
Growth hormone
Fertility hormones
Too much? Prolactinoma
Cushing’s
Acromegaly
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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
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Scan
Meningioma Craniopharyngioma
Rathke’s cleft cyst
Adenoma
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What do the eye tests show?
Visual fields
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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
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How are we going to achieve it?
Medical treatment
Replacement medication
Treatment of excess hormones
Tablets/injections
Surgery
Radiotherapy
Combination of the above
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The surgeon’s
perspective
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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
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Tricks of the trade
Microscope/Endoscope
Navigation
Interventional MRI
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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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