When a person sees a complex medical term, he begins to disassemble it into its components in order to understand his disease. Therefore, his first question to himself will be: “What is the pituitary gland responsible for?”. After a thorough search for information, he will find out that this is an endocrine gland that regulates the work of all other glands in the body. Further research will lead the patient to a list of hormones and target organs produced by him. And only after that he will finally decide to find out what the phrase "pituitary prolactinoma" means. This is a tumor that produces too many hormones for the body to handle. Excess prolactin and causes the characteristic clinical symptoms. But first things first.
What is the pituitary gland?
What is the pituitary gland responsible for? The pituitary gland is a part of the midbrain, located on its basal surface, in a bone formation called the Turkish saddle. This gland produces hormones that regulate human growth, metabolic rate and reproduction of offspring. The pituitary gland is the conductor of the endocrinesystems. Interacting with the hypothalamus, they together control the body, providing its vital functions.
There are three parts or lobes in the pituitary gland:
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The anterior lobe produces tropic hormones. They are so called because they affect certain organs and are chemically attuned to their tissues. These include:
- thyroid-stimulating hormone (associated with the thyroid gland);
- adrenocorticotropic hormone (stimulates the adrenal glands);
- follicle-stimulating hormone (controls sexual function, induces egg maturation);
- luteinizing hormone (stimulates ovulation);
- growth hormone is responsible for growth;- luteotropic hormone, or prolactin (regulates the appearance of colostrum and milk in pregnant women, is responsible for maternal instinct). Pituitary prolactinoma develops in the anterior lobe, it "perverts" the work of luteotropic hormone.
- Vasopressin is secreted in the posterior lobe (responsible for maintaining normal blood pressure and fluid in the tissues), as well as oxytocin, which is so necessary during pregnancy and feeding a child. It acts on smooth muscle to contract.
- Melanocytes, the hormones that stimulate skin cells, are synthesized in the middle lobe.
Functions, as you might guess, the pituitary gland is diverse. It controls cell division and protein synthesis to build new tissues. In addition, it regulates the maturation of eggs and sperm, as well as the body's response to the effects of sex hormones. Interferes with the immune system by stimulating or inhibiting functionthyroid gland. Controls the level of blood pressure in the vessels, the amount of fat mass and the quality of sleep. The pituitary gland is busy 24 hours a day, 7 days a week, all our lives.
Prolactin - what is it?
Having a little understanding of the anatomy and physiology of the endocrine system, you can proceed to a more detailed analysis of it. Of course, with a swoop, without special training, it will not be easy, but you can at least try. In the diagnosis, in addition to the word "pituitary gland", there was also prolactin. What is it?
Prolactin is one of the hormones secreted by the acidophilic cells of the anterior pituitary gland. According to its chemical structure, it belongs to protein structures. Scientists identify a whole family of substances that have similar molecular characteristics. These include:
- prolactin;
- proliferin (controls the division of connective tissue cells);
- somatotropin;- placental lactogen (secreted during pregnancy).
The currently known properties of prolactin are directly or indirectly responsible for sexual function and reproduction. The target organ is, as the name implies, the mammary glands. The hormone stimulates the production of colostrum and its conversion into milk. In puberty and during pregnancy, he is responsible for the growth and development of the mammary glands, the number of lobules and ducts. An interesting fact: prolactin receptors are found in almost all organs and tissues of the human body, but what effect it has on them is still unknown.
Pituitary prolactinomaoccurs due to mutations in the cells of the adenohypophysis. It provokes excessive production of prolactin and enhances its properties, which affects the well-being and appearance of patients. Fortunately, the diagnosis and treatment of this pathology is already known and successfully tested, so this diagnosis is not a sentence at all.
Prolactinoma
Prolactinoma of the pituitary gland is one of the most common benign diseases of the anterior pituitary gland (according to statistics, up to 30 percent of all diagnosed tumors). It occurs in women of childbearing age. The ratio between the representatives of the stronger and the fair sex is 1 to 6.
Its dimensions, as a rule, do not exceed two or three millimeters, but men can also have large formations - more than a centimeter in diameter. These tumors are hormonally active, as they produce prolactin. Normally, it is synthesized in both sexes. Prolactin can have an effect on organs both by itself and in conjunction with luteinizing and follicle-stimulating hormones. Their action is especially pronounced during pregnancy and lactation. But beyond that, they regulate the menstrual cycle and the onset of ovulation.
Excessive amount of the hormone leads to the opposite effect. A woman becomes barren, that is, she cannot conceive and bear a child. Men, on the other hand, who have high titers of prolactin, experience problems with potency and erection, note subjective and objective breast enlargement.
Reasons
Scientists have not yet figured out for sure why a person has thisneoplasm, but noticed some common features that are characteristic of all patients with a similar diagnosis.
First of all, of course, we are talking about congenital genetic disorders of the endocrine system. As a rule, these are multiple neoplasias (that is, there are tumors in almost all endocrine glands). There is an excess production of not only prolactin, but also hormones of the thyroid and parathyroid glands, pancreas, adrenal glands, pituitary gland and the presence of ulcers in the stomach.
It is known that close relatives have a higher chance of getting this pathology than the average for the population. Modern genetics does not give up and is looking for genes responsible for changing the characteristics of adenohypophysis cells, but so far there has been no success in this area.
Classification
Pituitary adenoma (prolactinoma) can vary in location within the Turkish saddle. There are two groups of tumors:
- Intrasellar prolactinomas that do not exceed one centimeter in size and do not extend beyond the bony borders of the pituitary fossa.
- Extrasellar prolactinomas that are large and grow beyond the Turkish saddle.
Severity of symptoms depends on the size of the tumor. This applies not only to the specific action of the hormone. A voluminous tumor compresses other brain structures, causing general and focal neurological symptoms. This may be blindness, loss of smell, damage to other cranial nerves (trigeminal, facial, oculomotor). Common symptoms include headaches,depressed mood, anxiety, irritability and emotional lability.
Pituitary prolactinoma: symptoms in women
For a long time, a woman may not notice disturbing changes in her body, especially if she had problems with the menstrual cycle before the disease. In patients, there is a decrease in the number of days of menstruation, scarcity of discharge or their absence at all. Ladies who wish to have a baby are unable to do so because ovulation does not occur.
What other symptoms do women have? Pituitary prolactinoma stimulates the production of colostrum and milk even in those women who are not preparing to become mothers. The liquid can be released in drops during mechanical compression of the areola or flow out on its own (usually due to a large amount of milk). Women with these symptoms first of all think of breast cancer or other local changes, but with careful examination, you can find the root of the problem.
Signs of pituitary prolactinoma in women are not only the secretion of colostrum and milk, it is also an increase in bone fragility up to osteoporosis. In addition, a deficiency of other sex hormones, such as estrogen, causes fluid retention in the body and rapid weight gain. Appearance can change dramatically - polymorphic acne on the skin, increased hairiness above the upper lip and on the tops of the auricles. All this should lead the doctor to the idea of a pituitary tumor.
Symptoms in men
Prolactinoma of the pituitary gland in men is manifested by a decrease in testosterone levels and a violation of the formation of germ cells. That is, it also causes sterility. But along with aspermia, erection disappears, libido decreases, potency decreases.
Besides this, representatives of the stronger half notice an increase and change in the shape of the mammary gland - gynecomastia. As a rule, it occurs in professional athletes focused on gaining muscle mass, and in a person who does not take steroids, it should be a dangerous sign. Sometimes milk may leak from enlarged breasts.
Among other things, in men, atrophy of the gonads occurs over time, secondary sexual characteristics disappear, excessive bone fragility and muscle weakness appear.
Diagnosis
A pituitary tumor (prolactinoma) is most often detected after a neuroimaging examination (magnetic resonance imaging). Moreover, we need not just an overview image, but a targeted search for the pathology of the pituitary gland using a contrast agent - gadolinium, tropic to neuroendocrine tissue. MRI allows you to determine the size and location of the neoplasm.
When the tumor is small, up to one centimeter, it is necessary to use computed tomography, as it is more informative. CT clearly shows the bone structures and their changes in the process of adenoma growth.
But in addition to instrumental methods that are necessary for final confirmationdiagnosis and preparation for surgery, there are also laboratory diagnostic methods. First of all, this is the determination of the level of prolactin in the blood. The analysis should be carried out three times, on different days of the menstrual cycle, in order to exclude false positive or false negative results caused by stress or physiological fluctuations. A result showing more than 200 nanograms per milliliter is almost 100% evidence of a tumor.
If your prolactin levels fluctuate between 40 and 100 nanograms, then there is a good chance that these readings are caused by low thyroid function, breast trauma, or impaired kidney function. Of course, these diagnoses also do not inspire optimism.
The test with thyroliberin is the most indicative. After its intravenous administration, after half an hour, an increase in the production of prolactin is observed. The concentration of the hormone should be at least twice the baseline. With prolactinoma in patients, the amount of prolactin in the blood does not change or increases slightly. If a pathological increase in the level of the hormone is not caused by a tumor, but by other reasons, then the reaction to thyroliberin will be close to normal.
Do not forget about the consultation of related specialists and a thorough patient survey. In order to suspect a pathology, sometimes it is enough to ask the right questions.
Treatment
Treatment for pituitary prolactinoma is usually medical. Therapy is aimed at lowering the level of the hormone and leveling it.negative effects. Selection of drugs and schemes for their administration are carried out only by an endocrinologist under the control of laboratory diagnostics. The doctor's arsenal includes drugs such as Bromkriptin, Levodopa, Cyproheptadine, Cabergoline and others. Most patients are helped by the appointment of "Bromocriptine". The effect becomes noticeable after a few weeks. But it has a large number of side effects, so the best option is Cabergoline. In addition, it is convenient to use (two sessions per week are enough).
In the process of therapy, the size of the tumor decreases, the secretion of prolactin decreases, normal vision returns, and colostrum stops flowing. In women of childbearing age, menstruation reappears, childbearing function is restored. Men stop being sterile, sex drive returns.
If after a long course of conservative therapy the situation has not changed for the better or there is a negative trend, then the neurosurgeon, together with the endocrinologist, considers the issue of surgical intervention. For patients with contraindications to surgery, there is an alternative - radiation therapy. But it has drawbacks: pituitary failure develops, and lifelong replacement therapy is needed.
Diet for pituitary prolactinoma is aimed at reducing excess weight, which appeared on the background of hormonal failure. An endocrinologist or nutritionist will help develop a nutrition plan that will contain all the necessary macro and micronutrients, as well as haveincreased content of calcium and phosphorus, necessary for the prevention of osteoporosis. Proper nutrition can be followed even after the disease is defeated.
Treatment of pituitary prolactinoma with folk remedies is highly discouraged by specialists, since infusions and decoctions do not bring the desired effect, but at the same time they inhibit the function of the thyroid gland and adrenal glands. This can negatively affect the patient's well-being, as well as the prognosis for recovery. If you really want to torture yourself with grandmother's recipes, be sure to consult your doctor.
Forecast and prevention
Can pituitary prolactinoma be cured? The consequences of the impact of excess production of hormones on the body are such that, even if the tumor itself disappears, a person will restore lost functions for a long time. In addition, doctors do not make any predictions about the speed of recovery and the success of treatment.
Relapse occurs in about half of patients, and after surgery, the statistics are even lower - only thirty percent of cures.
Is a diagnosis of pituitary prolactinoma a death sentence? It is difficult to make predictions. Treatment can take years and produce no results. Once every couple of years, doctors advise taking a break between courses of medications to unload the kidneys and liver. But at the same time, the abolition of drugs can provoke malignancy and tumor growth.
Compulsory dispensary observation is established for patients. Every yearthey should do computed or magnetic resonance imaging of the brain, consult an ophthalmologist, gynecologist and endocrinologist, and also take tests for prolactin levels. Such a thorough examination, comparison of indicators in dynamics and timely adjustment of therapy make it possible to make some assumptions about the recovery of patients.
