Pituitary adenoma is a tumor formation of a benign nature. It comes from the glandular tissue located in the anterior pituitary gland. From a clinical point of view, pituitary adenoma is expressed by ophthalmic-neurological (eye movement disorders, headache, double visual fields and their narrowing) and endocrine-metabolic syndromes, where, depending on the type of disease, acromegaly, sexual dysfunction, hypogonadism, gigantism, galactorrhea can be diagnosed, hyper- and hypothyroidism, hypercortisolism.
Diagnosis is established on the basis of information obtained as a result of CT of the Turkish saddle, angiography of the brain of the head, radiography, MRI, ophthalmological and hormonal examinations. Pituitary adenoma (ICD code D35-2) is treated with radiation, radiosurgery and transcranial or transnasal removal.
The essence of pathology
The pituitary is placedat the base of the skull, in the deepening of the Turkish saddle. It has posterior and anterior lobes. A pituitary adenoma is a pituitary tumor that begins in the tissues of the anterior lobe. It produces six hormones that regulate the functioning of the endocrine glands: somatotropin, lutropin, thyrotropin, prolactin, adrenocorticotropic hormone, follitropin. Judging by the statistics, pathology occurs in only ten percent of all tumors inside the skull that occur in neurology. Mostly appears in middle-aged patients (30 to 40 years old).
Disease classification
The difficulty of classifying this disease is that anatomically, the pituitary gland belongs to the nervous system, but from a functional point of view, to the endocrine.
Pituitary adenoma is classified according to the following criteria:
1. Adenomas are hormonally active (adenomas of the plurihormonal type are able to secrete a number of hormones, for example, prolactosomatotropinoma). The most common varieties are:
- somatotropinoma;
- thyrotropinoma;
- gonadotropinoma;
- prolactinoma;
- corticotropinoma.
2. Hormonally inactive adenomas are subdivided depending on morphological properties:
- “silent” adenomas are corticotrophic, somatotrophic (of the first and second types), lactotrophic, thyrotrophic, gonadotrophic;
- null cell adenomas;
- oncocytomas.
3. Depending on tumor size:
- microadenoma: no more than ten millimeters;
- picoadenoma: no more than three;
- macroadenoma: more than ten millimeters in diameter;
- giant: 40-50+.
4. According to the features of the location in relation to the Turkish saddle and growth:
- endosellar growth, that is, inside the saddle;
- infrasellar (the direction of growth is down);
- suprasellar (up);
- retrosellar (back, namely under the hard shell of the clivus of the brain);
- antesellar (growth into orbit, lattice maze);
- laterosellar (into the cavity of the cavernous sinus, sideways, into the fossa under the temple, etc.).
If during the clinical signs of excessive secretion of pituitary hormones the correct diagnosis is not established and the neoplasm is still growing, neurological and ophthalmological symptoms appear, changes of which are possible due to the direction of tumor growth.
Reasons for appearance
In modern medical science, the pathogenesis and etiology of pituitary adenoma remain the object of research. It is generally accepted that an adenoma can appear under the influence of a number of provoking factors, such as neuroinfection (brucellosis, head brain abscess, tuberculosis, poliomyelitis, neurosyphilis, meningitis, cerebral malaria, encephalitis, etc.), craniocerebral trauma, negative effects on the fetus during time of intrauterine development. Recently, it has been noticed that in women, pathology may be due to prolonged use of oral contraceptives.
Pituitary adenoma in children develops in rare cases. These neoplasms are usually benign.
Due to the fact that the pituitary gland regulates the hormonal background of the body, even with minor changes in its structure, disturbances in the child's mood, his ability to concentrate, and also in general development can begin.
Adenomas also often cause headaches and vision problems.
Scientists show that the disease in some cases appears due to excessive hypothalamic stimulation of this organ, which is a reaction in response to the primary decrease in the hormonal activity of the endocrine glands in the periphery. A similar mechanism for its appearance is possible with hypothyroidism and primary hypogonadism.
What is it - an adenoma of the pituitary gland of the brain, we explained. How does it manifest?
Signs of disease
Pituitary adenoma is clinically manifested as a series of ophthalmic-neurological signs caused by the pressure of the growing tumor on the structures inside the skull located in the area of the Turkish saddle. With the hormonally active nature of the adenoma, the main place in the clinical picture will belong to the endocrine-metabolic syndrome. Changes in a person's condition are often associated not with hyperproduction of the pituitary tropic hormone, but with the target organ that it affects and activates. Signs of endocrine-exchange syndrome are directly determined by the characteristics of the tumor. However, on the other hand, pathology may be accompanied by some featurespanhypopituitarism, which develops due to the destruction of the pituitary tissue by a growing tumor. Symptoms of a pituitary adenoma appear in various variations.
Hypopituitarism
Such a phenomenon as hypopituitarism is inherent in tumors of large size. It appears due to the destruction of pituitary tissues caused by tumor enlargement. This pathological condition is characterized by decreased libido, sexual dysfunction, impotence, hypogonadism and hypothyroidism. Patients also experience weight gain, depression, weakness, and dry skin.
Symptoms of a pituitary adenoma are quite unpleasant.
Ophthalmo-neurological syndrome
Ophthalmo-neurological symptoms accompanying pathology depend largely on the prevalence and direction of neoplasm growth. Most often it is a headache, eye movement disorders, diplopia and changes in visual fields. Headache appears due to pressure exerted on the Turkish saddle by a pituitary adenoma. She is dull, she is not affected by the position of the body, there is no nausea. Patients with this disease often complain that the headache is not always relieved by analgesics. It is most often localized in the temporal and frontal regions, in the back of the orbit. There may be a sudden increase in headache with pituitary adenoma, due to either intensive growth of the tumor, or hemorrhage in its tissue.
saddles. A long-existing pathology can cause optic nerve atrophy. With the lateral direction of growth of the adenoma, it eventually compresses the branches of the third, fourth, fifth and sixth nerves of the skull. Because of this, defects in the oculomotor function appear, that is, ophthalmoplegia, as well as diplopia (double vision). There may be a decrease in visual acuity. When a pituitary adenoma grows into the bottom of the sella turcica and further spreads to the sphenoid or ethmoid sinus, a person develops nasal congestion, which mimics the clinic of nasal tumors or sinusitis. When directed upwards, the structures of the hypothalamus are damaged, and the patient's consciousness may also be disturbed.
Signs of pituitary adenoma are important to recognize in a timely manner.
Endocrine-metabolic syndrome
Prolactinoma is a pituitary adenoma that secretes prolactin. It is accompanied by irregularities in the woman's menstrual cycle, infertility, amenorrhea and galactorrhea. Such symptoms can occur in combination or in isolation. Approximately 30% of patients with prolactinoma have problems in the form of acne, seborrhea, anorgasmia, moderate obesity, hypertrichosis. In men, first of all, ophthalmo-neurological signs appear, against the background of which gynecomastia, decreased libido, impotence and galactorrhea are possible.
Somatotropinoma is a pituitary adenoma that produces growth hormone, in adults it manifests itself in the form of acromegaly, in children - gigantism. In addition to the characteristic skeletal transformations in humans,develop obesity and diabetes mellitus, an increase in the size of the thyroid gland (nodular or diffuse goiter), most often not accompanied by impaired functioning. Often there is hyperhidrosis, hirsutism, excessive skin greasiness and the appearance of nevi, papillomas and warts on it. Polyneuropathy may develop, which is accompanied by paresthesias, pain and a decrease in the sensitivity of the limbs on the periphery.
Corticotropinoma is an adenoma that produces ACTH and is determined in almost one hundred percent of cases with Itsenko-Cushing's disease. The tumor manifests as the classic signs of hypercortisolism, increased skin pigmentation due to excessive production of melanocyte-stimulating hormone along with ACTH. There may be mental disorders. It is characteristic of this variety of adenomas that there is a tendency to transform the malignant type with further metastasis. With the early appearance of endocrine disorders, a tumor can be detected even before the ophthalmic-neurological signs appear due to its growth.
Gonadotropinoma - such an adenoma that produces gonadotropic hormones and has nonspecific characteristics, is most often determined by the presence of the usual ophthalmic-neurological symptoms. The clinical picture may include a combination of galactorrhea (due to increased prolactin secretion by the pituitary tissues that surround the adenoma) and hypogonadism.
Thyrotropinoma is a pituitary adenoma that secretes TSH. With its primary character, it manifests itself in the formhyperthyroidism. However, with a secondary occurrence, one can speak of hypothyroidism.
Diagnosis of pituitary adenoma
The main diagnostic methods for pathology are X-ray and biochemical examination, that is, craniography, MRI tomography, computed tomography, radioimmunological method. If there is a suspicion of adenoma, then first of all, X-ray craniography (two projections), tomography of the area of the Turkish saddle is done to determine the characteristic properties of the volumetric intrasellar process, which causes transformations in bone structures (osteoporosis), as well as destruction of the back of the saddle, etc. Characteristic the feature is the bypass nature of its bottom. To determine the presence of a tumor and its structural specifics (cystic, solid, etc.), the size and direction of growth, computed tomography is used, and with contrast enhancement. With pituitary adenoma, thanks to MRI tomography, it is possible in some cases to establish the infiltrative development of the tumor. If there is suspicion of its lateral growth (that is, to the cavernous sinuses), cerebral angiography should be performed. By means of pneumocisternography, the displacement of chiasmal cisterns is determined, as well as the symptoms of an empty Turkish saddle.
A specific diagnostic method with high sensitivity for pituitary adenoma is radioimmunological detection of the concentration of pituitary hormones in the blood serum.
Diagnosis of such a disease must necessarily be complex. Suspicion of an adenomabe if the patient has ophthalmic neurological defects or endocrine-metabolic syndrome. The emotional lability of patients, the complexity of diagnostic search, slow growth, the possibility of overdiagnosis, and the clinical benign course of many adenomas, which receive expression, require careful and tactful dedication of patients to the results of the examination.
The specialist must first of all make sure that the endocrine-metabolic syndrome is not the result of the use of a number of drugs (antidepressants, antipsychotics, antiulcer drugs that cause galactorrhea, or corticosteroids that affect the appearance of cushingoidism, etc.).) or neuro-reflex effects (increased palpation by the patient of the mammary glands, the presence of a contraceptive inside the uterus, chronic type adnexitis), which can contribute to the formation of reflex galactorrhea.
It is mandatory to rule out primary hypothyroidism, which is a common cause of galactorrhea. After that, the determination of the concentration of tropic pituitary hormones in the blood, as well as an x-ray analysis of the skull, is prescribed. A high increase in the concentration of this hormone, along with radiographic symptoms of pituitary adenoma, confirms the diagnosis.
Special stress pharmacological tests are also used to detect an abnormal response to pharmacological influence from the adenomatous tissue. If an adenoma is suspected, the patient should be referred forconsultation with an ophthalmologist. In the study of visual fields and visual acuity, as well as the analysis of the fundus, visual disturbances or chiasmal syndrome can be established, and in some cases, defects in the oculomotor nerve.
With a low concentration of pituitary hormones in the blood and an indication in the X-ray examination of the presence of volumetric formation in the area of the Turkish saddle, MRI, computed tomography, cerebral angiography and pneumocisternography are used for pituitary adenoma.
Diagnosis of the differential type is carried out with tumors that are hormonally inactive, which are located in the area of the Turkish saddle, with pituitary-hypothalamic insufficiency (non-tumor origin), with tumors that are not localized in the pituitary gland and produce peptide hormones. This neoplasm must be differentiated from the syndrome of an empty Turkish saddle, which is characterized by the occurrence of an ophthalmic neurological syndrome.
How is pituitary adenoma treated?
Features of the treatment of pathology
Conservative treatment can be applied mainly in relation to small prolactinomas. It is carried out with prolactin antagonists, for example, Bromkriptin. If the adenoma is small, then radiation methods can be used to influence the tumor: remote proton or radiation therapy, gamma therapy, stereotactic radiosurgery, that is, the introduction of a radioactive substance directly into the tumor tissue.
Patients with a large adenoma or with accompanying complications (visual defects, hemorrhage,the appearance of a cyst in the brain of the head), a neurosurgeon should be consulted to consider the possibility of removing the pituitary adenoma. The operation to eliminate the neoplasm can be performed by the transnasal method using endoscopic techniques. Macroadenomas are removed transcranially, that is, with the help of craniotomy.
Treatment of pituitary adenoma can give some complications. More on that later.
Consequences and expected complications
- Vision defects.
- Injury to he althy pituitary tissues.
- Impaired circulation in the brain.
- Infection.
- Liquorrhea.
If the endoscopic method was used, then the negative consequences after surgery are minimized.
A patient is in the hospital after a pituitary adenoma has been removed through the endoscopic method, for a short time if there were no complications during the course of the operation. Timing variation: within 1-3 days.
For each patient after discharge, a rehabilitation program is developed on an individual basis to avoid recurrence of the disease.
What awaits a person with a pituitary adenoma after surgery?
Forecast
Although it is a benign neoplasm, as it enlarges, like other brain tumors of the head, it becomes malignant due to compression of the anatomical structures that surround it. The size of the tumor also affects the possibility of its complete removal. Pituitary adenoma over twocentimeters in diameter is associated with the likelihood of recurrence after surgery. It can happen within five years.
Also, the prognosis of pituitary adenoma depends on its variety. For example, with microcorticotropinomas, in 85% of cases, the restoration of the functioning of the endocrine system in full after surgical therapy is noted. In patients with prolactinoma and somatotropinoma, this figure is much lower - from 20 to 25%. Some data suggest that after surgical treatment, on average, 67% recover, with relapses in 12% of cases. Sometimes, with hemorrhage into an adenoma, self-healing occurs, which is especially common with prolactinomas.
Possible consequences of pituitary adenoma are best known in advance.
Pregnancy and adenoma
If prolactin-secreting adenomas, in the absence of adequate therapy, such concepts are often incompatible. Due to the secretion of prolactin in excess by the tumor, a woman fails to become pregnant. It happens that such a neoplasm appears already directly during pregnancy.
Other types, in which the prolactin concentration in the blood remains within normal limits, do not interfere with conceiving a baby. Pituitary adenoma surgery is not performed during this period.
If such a disease is detected, the patient should visit a gynecologist, neurosurgeon and endocrinologist throughout the pregnancy.
Prevention
For prevention, it is recommended to avoid the occurrence of traumatic brain injuries, on timetreat various infectious diseases to prevent infection of the brain, and avoid using oral contraceptives for too long.
If neurological, ophthalmic and hormonal abnormalities are detected, you should immediately seek qualified medical help.
We examined the adenoma of the pituitary gland of the brain. What it is is now clear.
