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Genetic counseling: Pituitary Tumor

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Pituitary Tumor

IntroductionEdit

  • Acknowledge prior contact and receipt of family history information
  • Assess the most important concerns since there are so many issues at hand
  • Discuss family plans (timing, size, etc.) and how those plans may be influenced by what is learned today

Intake and Family HistoryEdit

  • Review family history information and personal health information already obtained
  • Use pedigree to make the review easier
  • Specifically ask about cancer in the family
  • Ask about pituitary tumor
    • When was it diagnosed? How? By whom?
    • What symptoms was she having?
    • Did she receive any treatment beside the drug mentioned?
    • Was surgery or radiation therapy ever discussed?
    • Has her physician discussed recurrence risks with her?

What is the Pituitary Gland?Edit

  • The pituitary gland is a small, bean-shaped gland located in the center of the brain just above the back of the nose
  • The pituitary gland makes hormones that affect the growth and functions of other glands in the body; therefore it is sometimes called the "master gland"
  • Some hormones produced by the pituitary include: Thyroid Stimulating Hormone, Growth Hormone, Adrenocorticotropic Hormone, Luteinizing and Follicle Stimulating Hormones, Vasopressin, and others
  • When there is an abnormality of the pituitary gland, it often produces either too much or too little of one or a combination of hormones. This can result in a variety of hormonal problems that can affect the whole body.
  • Enlargement of the gland can also cause visual disturbances and/or impairment

Pituitary TumorsEdit

  • Pituitary tumors or adenomas are almost always benign which means that they grow slowly and do not spread to other parts of the body
  • Pituitary tumors are rare.
  • Some may be "silent" lesions that are incidentally found at autopsy
  • The manifestations of a pituitary tumor depend on the hormones secreted by the tumor and the pattern of growth
  • Some hormonally active tumors are those that produce adrenocorticotropic hormone (ACTH), prolactin, or growth-hormone
  • Hormonally-inactive adenomas are often larger and may exhibit invasive properties. Thus, the likelihood for blindness is greater in patients with this tumor type
  • Pituitary tumors are seen in one of the multiple endocrine neoplasia (MEN) syndromes. MEN type I is well recognized, dominantly inherited, and comprises tumors of the parathyroid, pancreas and pituitary. Eighty percent of patients have involvement of 2 or more glands, and pituitary tumors occur in 54% to 80% of patients with MEN I.
  • MRI most readily determines the presence of a pituitary tumor, although it may also be established by CT (computer tomography) scan.
  • Many patients experience visual loss. Headaches occur in about 20%.

TreatmentEdit

  • Treatment depends upon the type of tumor and if it extends into the brain around the pituitary.
  • Hormone-secreting tumors may be treated with surgery or radiation therapy. Drug therapy with bromocriptine has been used with success in patients with prolactin-secreting tumors.
  • Lesions that extend beyond the confines of the pituitary often require radiation therapy and surgery

Risk forEdit

  • I could not find a population rate for pituitary tumors, only that they are "very rare"
  • sister was probably treated with bromocriptine which was used in the past for lactation cessation and is currently used to treat prolactin-secreting pituitary tumors
  • Her tumor was likely small at the start, and she has responded well to treatment thus far
  • Even if sister has a recurrence of the tumor, it will not affect the risk that this couple would have a child with a pituitary tumor

ReferencesEdit

  • Buckman, Robert. What you Really Need to Know about Cancer, p61.
  • CancerNet (A service of the NCI) online database
  • DeVita, Vincent T., Samuel Hellman, and Steven A. Rosenbert. Cancer: Principles & Practice of Oncology. Volume 2: pp1725, 2066-2068
  • Genetics in Clinical Oncology, pp108-109.
  • Pituitary Network Association (PNA) website

NotesEdit

The information in this outline was last updated in 2002.

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