Pituitary Tumors

10% of diagnosed brain neoplasms

Peak incidence fourth to sixth decade of life

Related to specific hormone-related effects, including difficult airway management; cardiovascular complications (hypertension, coronary artery disease, cardiomyopathy); respiratory compromise (obstructive sleep apnea); and endocrine and lyte abnormalities

Airway management: Difficult mask ventilation and intubation, especially in acromegaly and Cushing disease

Cardiovascular risk: Htn, CAD, cardiomyopathy

Respiratory complications: Obstructive sleep apnea and postop ventilatory support

Endocrine abnormalities: Acromegaly, hyperthyroidism, Cushing disease, panhypopituitarism, postop DI

EleLyte abnormalities: Hypernatremia secondary to DI

Rarely, management of elevated ICP

Tumors classified by size (macroadenoma >1 cm vs. microadenoma <1 cm) and hormone secretion (functioning vs. nonfunctioning).

Functioning tumors present with symptoms of hormone excess.

Nonfunctioning tumors are more likely to be macroadenomas and present with symptoms of mass effect: headache, visual loss (bitemporal hemianopsia), and hypopituitarism.

Pts rarely present with elevated ICP owing to obstruction of the third ventricle.