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DISORDERS OF THE CHIASM

DISORDERS OF THE CHIASM. 1. Anatomy. 2. Pituitary adenomas. Basophil adenoma Acidophil adenoma Chromophobe adenoma. 3. Craniopharyngioma. 4. Meningioma. Anatomy of chiasm and pituitary gland. III rd ventricle. Upper nasal fibres. Macular fibres. Craniopharyngioma.

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DISORDERS OF THE CHIASM

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  1. DISORDERS OF THE CHIASM 1. Anatomy 2. Pituitary adenomas • Basophil adenoma • Acidophil adenoma • Chromophobe adenoma 3. Craniopharyngioma 4. Meningioma

  2. Anatomy of chiasm and pituitary gland III rd ventricle Upper nasal fibres Macular fibres Craniopharyngioma Lower nasal fibres Optic chiasm Diaphragma sellae Posterior clinoid Anterior clinoid Pituitary gland Dorsum sellae

  3. Normal anatomical variations Central - 80% Prefixed - 10% Postfixed - 10%

  4. Pituitary adenomas Cushing syndrome ACTH Basophil Chromophobe PROLACTIN Acidophil Growth hormone Amenorrhoea Infertility Galactorrhoea Hypoglandism Impotence Infertility Gynaecomastia Galactorrhoea Acromegaly Gigantism

  5. Cushing syndrome • Moon face, pigmentation and • hirsutism • Hypertension and diabetes • Obesity, skin striae, bruising and • muscle weakness • Ankle oedema and osteoporosis

  6. Acromegaly Enlargement of hands and feet Enlargement of lower jaw

  7. Acromegaly • Facial coarseness • Organomegaly • Carpal tunnel syndrome and • cardiomyopathy • Hypertension, diabetes and • gonadal dysfunction

  8. Visual field defects in pituitary adenomas LE RE HM CF Decussating fibres are most vunerable

  9. MRI of pituitary adenoma Sagittal Axial Coronal

  10. Treatment options for pituitary adenomas Radiotherapy Surgery Transfrontal Trans-sphenoidal Bromocriptine

  11. Craniopharyngioma Presents • In children with endocrine dysfunction • In adults with visual field defects LE RE CF HM The posteriorly crossing fibres are most vunerable Craniopharyngioma

  12. Meningioma Typically affect middle-aged women LE RE Junctional scotoma Tuberculum Sella meningioma Sphenoid ridge meningioma Olfactory groove meningioma

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