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Sunday, November 05, 2006

The Pituitay, Empty Sella, & Ruptured Aneurysms

The Pituitary is such a small part of the brain, about the size of a pea, and yet in controls so many functions. Its main function is to control the release of hormones throughout the body. The Pituitary is is conected to the hypothalmus by nerve fibers. There are several hormones that the pituiatry control the release of:


Melanocyte-Stimulating Hormone (MSH)

Gonadotropins: Luteinizing and Follicle Stimulating Hormones

Adrenocorticotropic Hormone (ACTH, corticotropin)

Growth Hormone (Somatotropin)

Follicle-stimulating hormone

Empty sella syndrome occurs in patients when spinal fluid is found within the space created for the pituitary. The most common cause is a large openening a membrane which sits on top of the pituitary. When this opening is large, the spinal fluid pressure is forcred down onto the pituitary and flattens it out within the sella. In most cases, the pituitary functions normally as evidenced by normal thyroid functions, normal tests of adrenal function, normal somatomedin-C levels, and regular menses. Some patients have empty sella syndrome as a result of other processes such as neurosarcoidosis pituitary tumors that have degenerated, etc. Rare patients have a congenital empty sella and a coexisting pituitary tumor.

Pituitary tumors are associated by function.Usually by what hormone they release.Pituitary adenomas are the fourth most common intracranial tumor after gliomas, meningiomas and schwannomas. The large majority of pituitary adenomas are benign (not malignant) and are fairly slow growing. Even malignant pituitary tumors rarely spread to other parts of the body. Adenomas are by far the most common disease affecting the pituitary. They more commonly affect people in their 30s or 40s, although they are diagnosed in children as well. Most of these tumors can be successfully treated. Pituitary tumors can vary in size and behavior. Tumors that produce hormones are called functioning tumors, while those that do not produce hormones are called nonfunctioning tumors.

Pituitarary Apoplexy Can occur When An Aneurysm near the pituitary ruptures. This can cause bleeding or hemorage in the pituitary . Pituitary aneurysms can be enough to cause symptoms and they often include headache, nausea, visual loss, double vision and altered mental status. Most patients also have undiagnosed hormone insufficiency prior to the apoplectic event. In patients with such symptoms, the diagnosis of pituitary apoplexy is best confirmed with an MRI of the brain with special attention to the pituitary. Conditions to consider when trying to establish the diagnosis of pituitary apoplexy include ruptured intracranial aneurysm, meningitis, brain stem stroke, cavernous sinus thrombosis, intracerebral hemorrhage, temporal arteritis and ophthalmoplegic migraine headache, but typicaly pituitary apoplexy is a condition that develops over hours to several days, typically resulting from hemorrhage and/or infarction of a pituitary macroadenoma.

Treatment for pituiray tumors


MRI Nueroarm Video