Pituitary adenoma: symptoms and treatment

Pituitary adenoma is a benign tumor of the anterior lobe of the pituitary gland. The pituitary gland is a small structure of the brain that controls the glands of internal secretion through the production of its own hormones. Adenoma of the pituitary gland can be hormonally active and inactive. From this fact, as well as the size of the tumor, the direction and the rate of its growth, the clinical symptoms of the disease depend. The main manifestations of the adenoma of the pituitary gland can be problems with vision, disruption of function thyroid gland, gonads, adrenal glands, disruption of growth and proportionality of individual parts of the body. Sometimes the disease is asymptomatic. Diagnosis of pituitary adenoma is based on the data of magnetic resonance imaging, ophthalmological examination, analyzes of the blood levels of individual hormones. Treatment of pituitary adenoma can be operative and conservative. From this article you can learn basic information about this disease, about its symptoms and treatment.

Where is the pituitary gland

The pituitary gland is a very small, but very significant part of the nervous system. It is located at the base of the brain, in the bone formation called the "Turkish saddle". Despite its small size, the pituitary gland produces hormones that regulate the activity of the endocrine organs of the whole organism. Therefore, when there is an adenoma of the pituitary (or other pathological processes in this area) is violated well-coordinated work of the whole organism, and the emerging symptoms can be masked under a completely different disease.

The adenoma of the pituitary gland is about 10% of the total number of all brain tumors. More common in people 30-40 years of age.. Disease often affects both men and women. The tumor is benign and characterized by slow growth.

Classification of adenomas of the pituitary gland

This type of tumors in medicine is usually classified according to several signs.

The size of the adenoma of the pituitary gland is:

• microadenomas (if the tumor size does not exceed 2 cm in diameter);
• macroadenomas (if the diameter of the tumor formation is more than 2 cm).

Microadenomas quite often do not give any clinical symptoms, especially if they do not produce hormones. This makes it difficult to diagnose the disease.

By the ability to synthesize the hormones of the pituitary adenoma are divided into hormonally active tumors and nonhormonal. Hormonal active tumors produce hormones, but in excess, that is, much more than the body needs. Accordingly, non-hormonal tumors do not produce hormones.

Hormoneally active pituitary adenomas are classified by the variety of hormone produced. It can be:

• somatotropinums (excessive formation of growth hormone);
• prolactinoma (a lot of prolactin is synthesized);
• corticotropin (an excess of adrenocorticotropic hormone);
• thyrotropinoma (increased production of thyroid-stimulating hormone);
• gonadotropinomas (excess of hormones that regulate the activity of the sexual glands).

Depending on what hormone is in excess, there are certain symptoms of the disease, which we'll talk about a little later.

In relation to the Turkish saddle and adjacent formations, the pituitary adenomas are divided into:

• located within the Turkish saddle (usually a microadenoma);
• Outside the Turkish saddle up or down;
• sprouting into a cavernous sinus and destroying the wall of a Turkish saddle.

Why there is an adenoma of the pituitary gland?

Clearly indicated the cause of the adenoma of the pituitary gland, medicine still does not know. It is well known that the adenoma of the pituitary gland is not a hereditary disease. It is assumed that its appearance can contribute to:

• suffered craniocerebral trauma;
• infectious diseases with central nervous system damage (encephalitis, meningitis, cerebral abscess, tuberculosis of the brain, brucellosis, neurosyphilis and so on);
• the effect of harmful factors on the mother's body during pregnancy (including smoking and drinking alcohol);
• in recent years, the dependence of pituitary adenomas on the prolonged use of oral contraceptives has been traced.

Symptoms of pituitary adenoma

Clinical signs of pituitary adenoma can be divided into two groups:

• ophthalmic-neurological, that is connected directly with growth of a tumor within the brain. Their occurrence is associated with the tumor's compression of a number of located formations, and this, primarily, the optic nerves;
• endocrine signs associated with the production of a tumor of certain hormones. To the same group of symptoms should be attributed and the phenomenon of insufficiency of individual hormones, which can occur when the tumor is destroyed by the hormone-producing cells of the pituitary gland. Therefore, it can be symptoms of both high levels of hormones and low.

Let us dwell on these groups of symptoms in more detail.

Ophthalmic-neurological symptoms

This group of symptoms is all the more pronounced, the larger the size of the tumor. Microadenomas may not manifest themselves at all by any of the ophthalmic-neurological symptoms due to the fact that they do not go beyond the Turkish saddle and do not squeeze the surrounding structures. Macro-adenomas almost always have at least one of the ophthalmic-neurological signs. So, it can be:

• headache. It is dull and aching in nature, does not depend on the position of the body, time of day, is not accompanied by nausea and vomiting, is localized in the frontal, temporal region, in the orbit, is poorly removed analgesics. Headache is associated with the pressure of a growing tumor on the walls of the Turkish saddle. If the headache increases dramatically, then this may be due to a hemorrhage into the tumor tissue or with sudden increased growth of the tumor;
• change of visual fields. This, in most cases, means the loss of the lateral halves of vision (the so-called bitemporal hemianopsia). This symptom appears as a result of compression of the growing adenoma of the optic nerves passing under the pituitary gland. At this point they carry out their crosshairs, therefore, depending on the degree of compression of the fibers of the optic nerves, prolapse The areas of sight can have various sizes: from insignificant black spots (points) in the field of view to the complete fall of half the field view. Quite often, patients describe their feelings as "looking into the tube". With prolonged compression of the optic nerves, atrophy of visual nerves, which is manifested by a decrease in visual acuity, and to correct this phenomenon with the help of lenses it is impossible;
• oculomotor disorders. These symptoms are associated with the compression of the nerves that carry innervation of the internal and external eye muscles. First of all, this is a double vision in the eyes, and it can be unstable, but only, for example, when looking at one side; this is a strabismus; this restriction of movements of one or two eyes to the side, up or down. Such symptoms usually arise in the lateral direction of the growth of the pituitary adenoma;
• a sense of nasal congestion and the flow of liquor from the nasal passages. This symptom is characteristic of macroadenomas of the pituitary gland and is associated with the spread of the process to the wedge or latticular sinus;
• paroxysmal disorders of consciousness (fainting). This symptom may appear with the pituitary macroadenoma growing up and squeezing the hypothalamus.

Endocrine signs

Such symptoms are associated with an excess of one or more hormones of the pituitary gland or with a lack of all hormones with large adenoma sizes.

Macadenomas squeeze the normal tissue of the pituitary gland, which leads to a decrease in the production of hormones. In this case, signs of panhypopituitarism develop:

• decrease in thyroid function (weakness, lethargy, swelling of body tissues, dry skin, weight gain body due to edema, poor tolerance of physical and mental loads, cold, decrease emotionality);
• decreased adrenal function (lowering blood pressure, fatigue, dizziness, decreased appetite, feeling nausea until vomiting);
• decreased sexual function (decreased sexual desire, impotence, anorgasmia, menstrual irregularities, infertility);
• in children and adolescents - growth impairment (lag in physical development).

Hormonal active tumors, depending on the type of hormone produced, can manifest themselves with various symptoms. Let us dwell on the clinical features of some of them:

• somatotropinomes show themselves more vividly in children and adolescents, because they cause the phenomenon of excess body growth (gigantism) or parts of it (called acromegaly). Disproportionate growth of individual parts of the body (more often brushes, feet, nose, lower jaw) may be accompanied by the appearance of pain and sensitivity disorders in these areas. In addition to these signs, both in children and adults, obesity, increased sweating and greasiness of the skin, excessive hair growth in body, the appearance of a large number of moles and warts, an increase in the size of the thyroid gland without disrupting its function, the emergence of sugar diabetes;
• corticotropinomas lead to an increase in the content of adrenocorticotropic hormone in the blood and cause the Itenko-Cushing syndrome. The main manifestations of this syndrome are increased blood pressure, excessive hair growth, skin pigmentation, obesity (with the predominant deposition of fat on the face, neck, chest and abdomen), muscle weakness, stretch marks on the abdomen of a reddish-cyanotic color (stria) decreased immunity. Corticotropinomas can be regenerated and become malignant, as well as metastases;
• prolactinomas cause menstrual irregularities in women up to the complete absence of menstruation, infertility, the allocation of breast milk from the mammary glands. In men, the main symptoms are disorders of potency, a decrease in sexual desire, an increase in the mammary glands (gynecomastia). Symptoms characteristic of both the female and male sex are skin acne, seborrhea, excessive growth of hair on the body. This is perhaps the most common type of pituitary adenoma;
• thyrotropinomas cause the thyroid gland to produce its hormones in excess. As a result, the phenomena of thyrotoxicosis develop: increased sweating, chills, fever, feverish eyesight, blood pressure, heart rhythm disturbances, weight loss, frequent and profuse urination, loose stools, emotional instability, tearfulness;
• Gonadotropinomas lead to a violation of the content of sex hormones. This is manifested by changes in sexual desire, a violation of the menstrual cycle, but less pronounced compared with those changes with prolactinomas. Gonadotrophinomas are rarely detected on the basis of similar symptoms, they are often found occasionally or in the presence of concomitant ophthalmic-neurologic changes.

Thyrotropinomas and gonadotropinomas are very rare.

Diagnosis of pituitary adenoma

Despite such a variety of clinical manifestations, it can be said that the diagnosis of pituitary adenoma is a rather difficult exercise. This is due primarily to the nonspecificity of many complaints. In addition, the symptoms of pituitary adenoma cause patients to refer to various specialists (ophthalmologist, gynecologist, therapist, pediatrician, urologist, sex therapist and even psychiatrist). And not always a narrow specialist can suspect this disease. That is why patients with such nonspecific and versatile complaints are subject to examination by several specialists.

In addition, the diagnosis of adenoma of the pituitary gland helps the study of blood on the content of hormones. Decrease or increase of a number of them in combination with existing complaints helps the doctor to make a diagnosis.

Previously, the radiography of the Turkish saddle was widely used in the diagnosis of adenoma of the pituitary gland. The revealed osteoporosis and destruction of the back of the Turkish saddle, the double-contour of its bottom served and still serve as reliable signs of adenoma. However, these are already late symptoms of the pituitary adenoma, that is, they appear already with a considerable length of adenoma existence.

A modern, more accurate and earlier method of instrumental diagnosis, in comparison with radiography, is magnetic resonance imaging of the brain. This method allows you to see the adenoma, and the more powerful the device, the higher its capabilities in the diagnostic plan. Some pituitary microadenomas due to their small size may remain unrecognized even with magnetic resonance imaging. Especially difficult is the diagnosis of non-hormonal slow-growing microadenomas, which may not manifest themselves at all with any symptoms.

Treatment of pituitary adenoma

All methods of treatment of adenomas of the pituitary gland can be divided into conservative and operative. Conservative methods include medical therapy and radiation treatment.

Unfortunately, drug treatment is effective only if there is a small amount of prolactin or somatotropin. With prolactinomas, Bromocriptine (Parlodel) is prescribed, which leads to a decrease in prolactin production, with somatotropinomas in the elderly - Octreotide. In the case of other varieties of pituitary adenomas or large prolactinomas, other methods of treatment should be used.

Radiotherapy for pituitary adenoma is another way to get rid of the pituitary microadenum. These are the following methods:

• remote radiation or proton therapy;
• gamma therapy;
• radiosurgical method.

The advantage of all these techniques is non-invasive treatment. Radiosurgical method is, perhaps, the most innovative and modern method among radiation, because it allows to irradiate tumor tissue with minimal effect on a number of located normal tissues, which reduces the number of side effects from irradiation. In addition, this effect can be carried out even on an outpatient basis. It should only be taken into account that the effect of irradiation develops within a few months.

• transcranially - by cranial trepanation;
• transnazalno (transsphenoidal) - from the side of the nose.

Naturally, the first way of access is more traumatic, because the surrounding brain tissue is affected. It is also associated with a risk of bleeding and infection complications. However, sometimes it is impossible to get to a tumor in another way. Transnasal access is a minimally invasive endoscopic technique, that is, when access to the tumor is carried out without incisions through a probe inserted through the nose. The entire operation process is visible under magnification on the monitor screen. This technique reduces to zero the risk of bleeding or infection complications.

Rare is a clinical situation, when the adenoma of the pituitary gland becomes an accidental finding in the examination for another disease. If the tumor does not produce hormones, it does not grow (as determined by repeated magnetic resonance imaging after a few months), it is possible to simply observe by the doctor, without any interference. If, however, during the re-examination, tumor growth is detected or she begins to produce hormones, then radiation or surgical treatment is recommended.

Sometimes pituitary adenomas give a relapse. In such cases, you may need to repeat the operation.

Thus, the adenoma of the pituitary gland is a multifaceted disease that is difficult to diagnose at an early stage of its existence. Each individual case of pituitary adenoma requires an individual approach from the attending physician. The most important thing that one should know to a person who has encountered such a problem is that the adenoma of the pituitary is curable!

Neurosurgeon, Cand. M. Andrei Zuev talks about what is the pituitary adenoma, its manifestations, the principles of diagnosis and treatment: