1. 다양한 임상양상을 보이는 Pituitary Gland Mass 내분비대사 내과 R3 이 윤 정

2. Normal pituitary gland

3. Contents Central diabetes insipidus Acromegaly Pituitary gland mass

4. Pituitary adenomas : most common cause of sellar masses,10 percent of all intracranial neoplasms  Microadenoma, Macroadenoma Pituitary hyperplasia Benign tumor : craniopharyngiomas and meningiomas Malignant tumors : germ cell tumors, sarcomas, chordomas, and lymphomas Metastatic disease Cysts : Rathke's cleft, arachnoid, and dermoid cysts Abscess Arteriovenous fistula of the cavernous sinus Lymphocytic hypophysitis Classification

5. Pituitary adenomas

6. Clinical manifestation Neurologic symptoms : visual impairment or headache Abnormalities related to undersecretion or oversecretion of pituitary hormones Impacted StructureClinical Impact Pituitary Hypogonadism Hypothyroidism Growth failure and adult hyposomatotropism Hypoadrenalism Optic chiasm Loss of red perception Bitemporal hemianopia Superior or bitemporal field defect Scotoma Blindness Cavernous sinus Opthalmoplegia ± ptosis or diplopia Facial numbness

7. Radiologic procedures  Magnetic resonance imaging (MRI)  CT scan : craniopharyngioma or meningioma is seen better by CT scan than by MRI Hormonal hypersecretion  Hyperprolactinemia : elevated of prolactin  Acromegaly : measurement of serum insulin-like growth factor (IGF)-I, oral glucose tolerance test with GH  Cushing's syndrome : Elevated 24 hour urine cortisol excretion,high- normal or high ACTH concentration  Gonadotroph adenomas Hormonal hyposecretion : Central diabetes insipidus, Hypopituitarism Pituitary incidentaloma Evaluation of sella mass

8. Evaluation of sella mass

9. Central diabetes insipidus Acromegaly Pituitary gland mass Contents

10. Cause of acromegaly

11. Clinical feature of acromegaly

12. Diagnosis and treatment of acromegaly

13. Giant pituitary adenoma: 뇌하수체 선종의 6 ∼ 23% 를 차지, 조직학적 으로 양성으로 서서히 성장하지만 침습적 성향을 보임. Yasagil 의 분류 : Large pituitary adenoma 를 종양의 크기에 따라 moderate(2 ∼ 4cm), large(4 ∼ 6cm), giant (>6cm) 으로 분류함. 남녀의 비에서 차이가 없음, 주로 40 ∼ 50 대에서 호발하며, 내분비학 적 증상 없이 시야장애가 오는 것이 특징임. 종양이 터어키안 밖으로 탈출되어 자라는 경우가 대부분이기 때문에 뇌하수체 기능 저하증의 기회는 많지 않음. Giant pituitary adenoma

17. Acromegaly Central diabetes insipidus Pituitary gland mass Contents

18. Decreased secretion or action of AVP 24-h urine volume is >50 mL/kg body weight and the osmolarity is <300 mosmol/L. Polyuria produces symptoms of urinary frequency, enuresis, and/or nocturia, disturb sleep and cause mild daytime fatigue or somnolence. Thirst and a commensurate increase in fluid intake (polydipsia) Clinical signs of dehydration are uncommon unless fluid intake is impaired Diabetes insipidus of Clinical characteristics

20. 1991.8 ~ 1995.12 25 subjects with CDI Age : 2 – 58 yrs old

21. 79 pts (1970-1976) Mean 7 yrs old Duration of F/U 7.6 yrs

22. 1. Thickened pituitary stalk → infiltrative disease : 29 pts (37%) 2. No hyperintense in post. Pituitary region : 74 pts (94%) MRI scans of the hypothalamic- pituitary region in a normal subjects

23. MRI scans of the hypothalamic- pituitary region in Central DI subjects

24. , October 5, 2000> <N Eng J Med

26. Gd-DTPA = Gadolinium diethylenetriamine pentaacetic acid Algorithm for diagnosis and management of central diabetes insipidus

27. Consistent lack of posterior pituitary hyperintensity : cardinal feature of CDI Thickening of the pituitary stalk : second feature of CDI Anterior pituitary hormone deficits with idiopathic CDI : frequent Progressive reduction of anterior pituitary size : commonly associated with higher risk of additional endocrine defect Increased anterior pituitary size with stalk thickening : strongly associated with presence of germinoma Special remark