We need to diagnose pituitary tumour much early than we do-Prof. John Wass


 Azra Naheed Memorial Lecture

We need to diagnose pituitary tumour much
early than we do - Prof.  John Wass

These patients get medical attention too late   

LAHORE: We need to diagnose the pituitary tumour much early than we do and these patients get medical attention too late. This was stated by Prof.  John A. H.Wass, Professor of Endocrinology, Oxford Center for Diabetes, Endocrinology and Metabolism while delivering Azra Naheed Memorial State of the Art lecture during the recently held International Medical Conference jointly organized by AZNMC and Royal College of Physicians at Lahore from February 26-28, 2016.

Tracing the historical background Prof. John Wass said that pituitary tumour are no more waste product of the brain.  Andrea was pioneer of anatomy.Geoffery Harris, Andrew and Roger got Nobel Prize in 1977 for their valuable contributions. It was Sheehan who in 1939 reported postpartum haemorrhage. Pituitary tumour are either functioning or non-functioning but the commonest of these are prolactinomas. In women these present with amenorrhea or glactorrhoea and infertility while in men they present as impotence   or loss of libido. It is essential that these symptoms are properly investigated by measuring prolactin levels in both men and women. Prolactinomas, Prof. John Wass opined respond to dopamine agonists but 10-15% does not respond to this therapy particularly the tumour which are large. Disconnection hyperprolactinomas results in prolactin elevation up to 3,000 mU/L but above these levels are likely to reflect a prolactinomas which mostly do respond to medical therapy. Cessation of treatment with dopamine agonists is rarely associated with long term normality of prolactin.

Prof. John Wass presenting mementoes to David Warrell and Prof. Saeed Hamid during the international
medical conference organized by AZNMC and RCP London at Lahore from February 26-28, 2016.

Nonfunctioning pituitary tumour occur in all age groups and they also decrease life expectancy. Primary treatment is with surgery and this is usually done by an experienced surgeon who is doing at least thirty to forty cases every year. With experience, the outcome is better. Post operatively one can use Cabergolineor Somastatin analogues but if the patient do not respond to both these drugs, radiotherapy may be helpful over a prolonged period of time to improve biochemical control.

Continuing Prof. John Wass said that this is a very rapidly advancing field. Now new treatments are available for acromegaly but the therapy is expensive and needs to be carried out in centers with experience in order to ensure optimum outcome. Over the years mortality from acromegaly has reduced. UK Acromegaly Register was started in 2012. He reiterated that one should send these patients to experienced surgeons as they will have much less mortality. He also referred to the monitoring of these patients and complications of acromegaly. He then talked about progression of hypopituitarism and benefits of Growth Hormone Replacement. It improves quality of life and psychological wellbeingis also improved. Bone mineral density also goes up. Active malignancy is a contra indication for Growth Hormone therapy. It can also lead to weight gain and carpel tunnel syndrome,

Prof. Khawja Saadiq Husain who was chairing this session in his remarks said that during his professional carrier he had seen one Sheehan syndrome and a very few cases of acromegaly. We have our limitations but we need to document and give our own figures. Cure rate is very good in such cases, he remarked.