The pituitary adenoma is a benign tumor formation. It comes from glandular tissue located in the anterior pituitary gland. From a clinical point of view, the pituitary adenoma is expressed as ophthalmic-neurological (impaired eye movements, headache, double vision and narrowing) and endocrine-exchange syndromes, where, depending on the type of disease, acromegaly, sexual defect, hypogonadism, gigantism, galactorrhea can be diagnosed , hyper- and hypothyroidism, hypercorticism.
The 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. The pituitary adenoma (the ICD assigns it the code D35-2) is treated with radiation exposure, a radiosurgical method, and through transcranial or transnasal removal.
The essence of pathology
The pituitary gland is located on the base of the skull, in the recess of the Turkish saddle. It has a posterior and anterior lobes. The pituitary adenoma is a pituitary tumor that begins in the tissues of the anterior lobe. She produces six hormones that regulate the functioning of the endocrine glands: somatotropin, lutropin, thyrotropin, prolactin, adrenocorticotropic hormone, follitropin. Judging by statistical data, pathology occurs only in 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 in classifying this disease is that anatomically the pituitary gland belongs to the nervous system, but from a functional point of view it belongs to the endocrine one.
The pituitary adenoma is classified on the following grounds:
1. Adenomas are hormone-active (adenomas of the plurigormonal type are able to secrete a number of hormones, for example, prolactosomatotropinoma). The most common varieties are:
- somatotropinoma;
- thyrotropinoma;
- gonadotropinoma;
- prolactinoma;
- corticotropinoma.
2. Hormone-inactive adenomas are divided according to morphological properties:
- “Silent” adenomas are corticotrophic, somatotrophic (first and second types), lactotrophic, thyrotrophic, gonadotrophic;
- null cell adenomas;
- oncocytomas.
3. Depending on the size of the tumor:
- microadenoma: not more than ten millimeters;
- picoadenoma: no more than three;
- macroadenoma: in diameter more than ten millimeters;
- giant: starting from 40-50 and more.
4. According to the peculiarities of location in relation to the Turkish saddle and growth:
- endosellar growth, i.e. inside the saddle;
- Infrasellar (growth direction - down);
- suprasellar (up);
- retrocellular (back, namely, under the hard shell of the brain slope);
- antesellar (growth into orbit, trellised labyrinth);
- laterosellar (into the cavernous sinus cavity, 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 ophthalmic symptoms appear, changes of which are possible due to the direction of tumor growth.
Reasons for the appearance
In modern medical science, the pathogenesis and etiology of the pituitary adenoma remain an object of research. It is generally accepted that adenoma is capable of appearing under the influence of a number of provoking factors, for example, neuroinfection (brucellosis, brain abscess of the head, tuberculosis, poliomyelitis, neurosyphilis, meningitis, cerebral malaria, encephalitis, etc.), craniocerebral trauma, and negative effects on the fetus during intrauterine formation time. Recently, it has been observed that in women, the pathology may be due to the prolonged use of oral contraceptives.
Pituitary adenoma in children develops in rare cases. Usually such neoplasms are 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 may 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 a primary decrease in the hormonal activity of the endocrine glands on the periphery. A similar mechanism of its appearance is possible with hypothyroidism and primary hypogonadism.
What is it - a pituitary adenoma of the brain, we explained. How does it manifest?
Signs of the disease
The pituitary adenoma is clinically manifested in the form of a number of ophthalmic-neurological signs, due to the pressure of an expanding tumor on the structures inside the skull located in the region of the Turkish saddle. With the hormonally active nature of the adenoma in the clinical picture, the main place will belong to the endocrine-exchange syndrome. Changes in the human condition are often associated not with the overproduction of the pituitary tropic hormone, but with the target organ that it affects and activates. Signs of endocrine-metabolic syndrome are directly determined by the characteristics of the tumor. However, on the other hand, some features of panhypopituitarism, which develops due to the destruction of pituitary tissue by a growing tumor, can accompany pathology. Symptoms of the pituitary adenoma are manifested in various variations.
Hypopituitarism
Such a phenomenon as hypopituitarism is inherent in large tumors. It appears due to the destruction of the pituitary tissues caused by the growth of the tumor. This pathological condition is characterized by a decrease in libido, sexual dysfunction, impotence, hypogonadism and hypothyroidism. Patients also experience weight gain, depression, weakness, and dry skin.
Symptoms of the pituitary adenoma are quite unpleasant.
Ophthalmic Neurological Syndrome
Symptoms of the ophthalmic-neurological accompanying pathology depend largely on the prevalence and growth direction of the neoplasm. Most often, this is a headache, impaired eye movement, diplopia and a change in the field of view. Headache appears due to pressure exerted on the Turkish saddle by the pituitary adenoma. She is dumb, she is not affected by the position of the body, there is no nausea. Patients with this disease often complain that headaches are not always relieved by analgesics. It is most often localized in the temporal and frontal areas, in the back of the orbit. A sudden increase in headache with pituitary adenoma may occur due to either intensive growth of the tumor or hemorrhage in its tissue.
The limitation of the scope of vision is determined by squeezing the increasing adenoma of the intersection of the nerves of the visual organs, which is located under the pituitary gland in the Turkish saddle. A long existing pathology can cause the appearance of optic atrophy. With the lateral direction of growth of the adenoma, it eventually squeezes 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). A decrease in visual acuity may be noted. When the adenoma of the pituitary gland of the Turkish saddle germinates and further spreads to the sphenoid or ethmoid sinus, a person has nasal congestion, which mimics a clinic of nasal tumors or sinusitis. When it is directed upwards, the structures of the hypothalamus are damaged, and disturbances in the patient's consciousness can also develop.
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 a complex 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, ophthalmic-neurological signs appear, against which gynecomastia, a decrease in libido, impotence and galactorrhea are possible.
Somatotropinoma is a pituitary adenoma that produces STH, in adults it manifests itself in the form of acromegaly, in children - gigantism. In addition to the characteristic skeletal transformations, people can 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 are hyperhidrosis, hirsutism, excessive skin sebum and the appearance of nevuses, papillomas and warts on it. Polyneuropathy may develop, which is accompanied by paresthesia, pain and a decrease in the sensitivity of the extremities on the periphery.
Corticotropinoma is an adenoma that produces ACTH and is determined in almost a hundred percent of cases with Itsenko-Cushing's disease. The tumor manifests itself in the form of classic signs of hypercorticism, increased skin pigmentation due to excessive production of melanocytostimulating hormone along with ACTH. There may be deviations in the psyche. 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 appearance of ophthalmic-neurological signs due to its growth.
Gonadotropinoma - such an adenoma that produces gonadotropic hormones and is characterized by non-specific characteristics, is most often determined by the presence of 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 form of hyperthyroidism. However, with a secondary occurrence, we can talk about hypothyroidism.
Diagnosis of the pituitary adenoma
The main diagnostic methods for pathology are considered to be x-ray and biochemical studies, that is, craniography, NMR tomography, computed tomography, radioimmunological method. If there is a suspicion of adenoma, first of all they do X-ray craniography (two projections), a tomography of the Turkish saddle section to determine the characteristic properties of the volumetric intracellular process, which causes transformations in the bone structures (osteoporosis), as well as the destruction of the back of the saddle, etc. the double contour of its bottom becomes a feature. To determine the presence of a tumor and its structural specificity (cystic, solid, etc.), the size and direction of growth, computed tomography is used, and with contrast enhancement. With pituitary adenoma due to NMR imaging, in some cases it is possible to establish the infiltrative development of the tumor. If there is a suspicion of its lateral growth (that is, to the cavernous sinuses), cerebral angiography should be performed . By means of pneumocisternography, the displacement of the chiasmal tanks and the symptoms of the empty Turkish saddle are determined.
A specific diagnostic method with high sensitivity for pituitary adenoma is the radioimmunological detection of the concentration of pituitary hormones in the blood serum.
Diagnosis of such a disease must necessarily be comprehensive. Suspicion of an adenoma may occur if the patient has ophthalmoneurological defects or endocrine-exchange syndrome. The expression of emotional lability of patients, the complexity of the diagnostic search, slow growth, the possibility of overdiagnosis and the benign clinical course of many adenomas require careful and tactful initiation of patients into the examination results.
The specialist should 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 the appearance of galactorrhea, or corticosteroids that affect the appearance of cushingoidism, etc.) or effects of the nervous -reflex (frequent palpation of the patient’s mammary glands, the presence of a contraceptive inside the uterus, chronic adnexitis), which can contribute to the formation of reflex galactorrhea.
Mandatory exclusion of hypothyroidism of the primary type, which is a common cause of galactorrhea, is required. After this, 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 the radiological symptoms of the pituitary adenoma, confirms the diagnosis.
To identify an abnormal reaction to the pharmacological effect of adenomatous tissue, special stress pharmacological tests are also used. If there is a suspicion of an adenoma, the patient should be referred for consultation to an ophthalmologist. When examining the fields and visual acuity, as well as analyzing the fundus, visual disturbances or chiasmal syndrome can be established, and in some cases, oculomotor nerve defects .
With a low concentration of pituitary hormones in the blood and an indication in the X-ray examination for the presence of volumetric formation in the region of the Turkish saddle, MRI, computed tomography, cerebral angiography and pneumocisternography are used for pituitary adenoma.
The differential type of diagnosis is carried out with hormone-inactive tumors that are located on the site of the Turkish saddle, with pituitary-hypothalamic insufficiency (non-tumor origin), with tumors that are not located in the pituitary gland and produce peptide hormones. This neoplasm must be differentiated from the empty Turkish saddle syndrome, which is characterized by the occurrence of ophthalmoneurological syndrome.
How is pituitary adenoma treated?
Features of the treatment of pathology
Conservative treatment can be applied mainly to small prolactinomas. It is carried out by prolactin antagonists, for example, "Bromocriptine." If the adenoma is small, then radiation methods of influencing the tumor can be applied: 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 complications accompanying it (vision defects, hemorrhage, the appearance of a cyst in the brain of the head) should consult a neurosurgeon 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. Transcranial way macroadenomas are removed, that is, using cranial trepanation.
Treating the pituitary adenoma can cause some complications. About it - further.
Consequences and suspected complications
- Vision defects.
- Injury to healthy pituitary tissues.
- Circulatory disturbance in the brain.
- Infection
- Liquorrhea.
If the endoscopic method was used, then the negative consequences after surgery are minimized.
The patient is in the hospital after the pituitary adenoma has been removed by the endoscopic method, not for long if there were no complications during the course of the operation. Variation of terms: within 1-3 days.
After discharge, a rehabilitation program is developed individually for each patient, which avoids the occurrence of relapses of the disease.
What awaits a person with pituitary adenoma after surgery?
Forecast
Although it is a neoplasm of a benign nature, with its enlargement, like other brain tumors of the head, it becomes malignant due to compression of the anatomical formations that surround it. The size of the tumor, in addition, affects the possibility of its complete removal. Pituitary adenoma over two centimeters in diameter is associated with the likelihood of relapse after surgery. It can happen over five years.
Also, the prognosis of the pituitary adenoma depends on its variety. For example, with microcorticotropinomas in 85% of cases, the restoration of the endocrine system in full is observed after surgical therapy. In patients with prolactinoma and somatotropinoma, this indicator is much lower - from 20 to 25%. Some data suggest that after surgical treatment, on average, 67% recover, relapses - in 12% of cases. Sometimes, with hemorrhage in the adenoma, self-healing occurs, which is especially common with prolactinomas.
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Prevention
For prophylaxis, it is recommended to avoid the appearance of traumatic brain injuries, to treat various infectious diseases in time to prevent infection of the brain, and also not to use oral contraceptives for too long.
If you find neurological, ophthalmic and hormonal abnormalities, you should immediately seek qualified medical help.
We examined the pituitary adenoma of the brain. What it is is now clear.