Disorders of the chiasm - No Slide Title
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DISORDERS OF THE CHIASM
1. Anatomy
2. Pituitary adenomas• Basophil adenoma• Acidophil adenoma• Chromophobe adenoma
3. Craniopharyngioma
4. Meningioma
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Anatomy of chiasm and pituitary gland
Upper nasal fibres
Macular fibres
Lower nasal fibres
Anterior clinoid
Pituitary gland
III rd ventricle
Craniopharyngioma
Optic chiasm
Diaphragma sellae
Posterior clinoid
Dorsum sellae
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Normal anatomical variations
Central - 80%
Prefixed - 10% Postfixed - 10%
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Pituitary adenomas
Cushing syndrome
ACTHBasophil
Growth hormone
Acromegaly Gigantism
AmenorrhoeaInfertilityGalactorrhoea
HypoglandismImpotenceInfertilityGynaecomastiaGalactorrhoea
PROLACTINChromophobe
Acidophil
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Cushing syndrome
• Moon face, pigmentation and hirsutism • Hypertension and diabetes
• Obesity, skin striae, bruising and muscle weakness• Ankle oedema and osteoporosis
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Acromegaly
Enlargement of hands and feet Enlargement of lower jaw
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Acromegaly
• Facial coarseness • Organomegaly
• Carpal tunnel syndrome and cardiomyopathy
• Hypertension, diabetes and gonadal dysfunction
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Visual field defects in pituitary adenomas LE RE
HM
CF
Decussating fibresare most vunerable
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MRI of pituitary adenoma
Sagittal
CoronalAxial
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Treatment options for pituitary adenomas
RadiotherapySurgery
Transfrontal
Trans-sphenoidal Bromocriptine
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Craniopharyngioma Presents
• In children with endocrine dysfunction• In adults with visual field defects
LE RE
HM
CF
The posteriorly crossingfibres are most vunerable
Craniopharyngioma
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Meningioma
Typically affect middle-aged women
LE REJunctional scotoma
Tuberculum Sellameningioma
Olfactory groove meningioma
Sphenoid ridge meningioma