When a person sees a complex medical term, he begins to disassemble it into 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 of information, he will find out that it 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 the hormones and target organs produced by him. And only after that he finally decides to find out what the phrase “pituitary prolactinoma” means. This is a tumor that produces too many hormones for the body to cope with. Excess prolactin also causes 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 endocrine system. Interacting with the hypothalamus, they together control the body, providing its vital functions.
In the pituitary gland, three parts or lobes are distinguished:
- The anterior lobe produces tropic hormones. They are so called because they affect certain organs and are chemically tuned 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). The pituitary prolactinoma develops precisely in the anterior lobe, it “perverts” the function of the luteotropic hormone. - In the posterior lobe, vasopressin is secreted (responsible for maintaining normal blood and fluid pressure in the tissues), as well as oxytocin, which is so necessary during pregnancy and lactation. It works on smooth muscles, contracting it.
- In the middle lobe, hormones stimulating skin cells, melanocytes, are synthesized.
Functions, as you might guess, the pituitary gland are 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. It interferes with the functioning of the immune system, stimulating or inhibiting the function of the thyroid gland. It 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, our whole life.
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, from a snap, 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 it is?
Prolactin is one of the hormones secreted by acidophilic cells of the anterior pituitary gland. In its chemical structure, it refers to protein structures. Scientists distinguish a whole family of substances that have similar molecular characteristics. These include:
- prolactin;
- proliferin (controls the division of cells of the connective tissue);
- 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 the 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 prolactinoma occurs 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
Pituitary prolactinoma refers to 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 strong and fair sex is 1 to 6.
Its dimensions, as a rule, do not exceed two to three millimeters, but large formations can occur in men - more than a centimeter in diameter. These tumors are hormonally active, as they produce prolactin. Normally, it is synthesized in representatives of both sexes. Prolactin can affect organs both on its own and in conjunction with luteinizing and follicle-stimulating hormones. Especially their effect is expressed during pregnancy and lactation. But beyond that, they regulate the menstrual cycle and the onset of ovulation.
Excessive amounts of the hormone have the opposite effect. A woman becomes barren, that is, she cannot conceive and bear a child. Men who have high titers of prolactin experience problems with potency and erection, note a subjective and objective enlargement of the mammary glands.
Causes
Scientists have not yet figured out for sure why a person has this neoplasm, but they noticed some common signs that are characteristic of all patients with a similar diagnosis.
First of all, of course, we are talking about congenital genetic disorders from the endocrine system. As a rule, these are multiple neoplasias (that is, tumors are present in almost all endocrine glands). There is an excessive production of not only prolactin, but also thyroid and parathyroid hormones, pancreas, adrenal glands, the 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 population average. Modern genetics does not give up and is looking for genes responsible for changing the characteristics of the cells of the adenohypophysis, but so far there has been no success in this area.
Classification
Pituitary adenoma (prolactinoma) may vary in location within the Turkish saddle. Two groups of tumors are distinguished:
- Intrasellar prolactinomas, which do not exceed one centimeter in size and do not go beyond the bone borders of the pituitary fossa.
- Extrasellar prolactinomas, large in size and growing beyond the Turkish saddle.
The severity of symptoms depends on the size of the tumor. This applies not only to the specific action of the hormone. A volumetric 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, mood depression, 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 even before the disease. In patients, there is a decrease in the number of days of menstruation, the scarcity of secretions or even their absence. Ladies who want to have a baby are not able to do this, since ovulation does not occur.
What other symptoms appear in women? Pituitary prolactinoma stimulates the production of colostrum and milk, even among the fair sex who are not preparing to become mothers. Liquid can be released in drops during mechanical compression of the areola or leak out on its own (usually due to the large amount of milk). Women with the appearance of such symptoms primarily think about breast cancer or other local changes, but with a thorough examination, you can find the root of the problem.
Signs of pituitary prolactinoma in women are not only colostrum and milk secretions, but also an increase in bone fragility up to osteoporosis. In addition, a deficiency of other sex hormones, such as estrogen, causes fluid retention and rapid weight gain. Appearance can change dramatically - polymorphic acne rashes on the skin, increased hairiness above the upper lip and on the tops of the auricles. All this should give the doctor the idea of a pituitary tumor.
Symptoms in men
Pituitary prolactinoma 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, an erection disappears, sexual desire decreases, potency decreases.
In addition, representatives of the strong half notice an increase and change in the shape of the breast - gynecomastia. As a rule, it occurs in professional athletes focused on a set of muscle mass, and in a person not taking steroids, it should be a dangerous sign. Sometimes milk can leak from an enlarged breast.
In addition, in men, atrophy of the gonads occurs over time, secondary sexual characteristics disappear, excessive brittle bones and muscle weakness appear.
Diagnostics
The pituitary tumor (prolactinoma) is most often determined after a neuroimaging examination (magnetic resonance imaging). And you need not just an overview picture, but an aimed 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.
With small sizes of the tumor, up to one centimeter, it is necessary to use computed tomography, as it is more informative. On CT, bone structures and their change during the growth of adenoma are clearly visible.
But in addition to instrumental methods that are necessary to finally confirm the diagnosis and prepare 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 must 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 almost completely indicates the presence of a tumor.
If the prolactin level ranges from 40 to 100 nanograms, then it is likely that such indicators are caused by a decrease in thyroid function, chest injuries or impaired renal function. Of course, these diagnoses are also not encouraging.
The most indicative test is with tyroliberin. After intravenous administration, an increase in prolactin production is observed within half an hour. 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 the pathological increase in the level of the hormone is caused not by a tumor, but by other reasons, then the response to thyroliberin will be close to normal.
Do not forget about the consultation of related specialists and a thorough interview of the patient. In order to suspect a pathology, sometimes it is enough to ask the right questions.
Treatment
Treatment of pituitary prolactinoma is usually medication. Therapy is aimed at reducing the level of the hormone and leveling its negative effects. Selection of drugs and their administration are carried out only by an endocrinologist under the supervision of laboratory diagnostics. The doctor’s arsenal includes such medicines as Bromkriptin, Levodopa, Cyproheptadine, Cabergoline and others. Most patients benefit from Bromkriptin. 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 sufficient).
During therapy, the size of the tumor decreases, the secretion of prolactin falls, normal vision returns, colostrum ceases to flow. In women of childbearing age, menstruation appears again, and reproductive function is restored. Men cease to be sterile, sex drive returns.
If after a long course of conservative therapy the situation has not changed for the better or negative dynamics have appeared, the neurosurgeon together with the endocrinologist are considering the question of surgical intervention. For patients who have contraindications for surgery, there is an alternative - radiation therapy. But she has disadvantages: pituitary insufficiency develops, and lifelong replacement therapy is necessary.
Diet with pituitary prolactinoma is aimed at reducing the excess weight that appeared on the background of hormonal failure. An endocrinologist or a nutritionist will help develop a nutrition plan that will contain all the necessary macro- and micronutrients, as well as have a high 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 inhibit the function of the thyroid gland and adrenal glands. This can adversely affect the patient’s well-being, as well as the prognosis for recovery. If you really want to torment yourself with grandmother's recipes, be sure to consult a doctor.
Forecast and Prevention
Is it possible to cure pituitary prolactinoma? The consequences of the effects of excess hormone production on the body are such that, even if the tumor itself disappears, the person will recover lost functions for a long time. In addition, doctors do not give any predictions about the speed of recovery and the success of treatment.
Relapse occurs in about half of patients, and after surgery, statistics are even lower - only thirty percent of cures.
Is the diagnosis of pituitary prolactinoma a sentence? Forecasting is difficult. Treatment may take years and produce no results. Once every couple of years, doctors advise taking a break between courses of drugs to relieve the kidneys and liver. But at the same time, the abolition of drugs can provoke malignancy and tumor growth.
For patients establish a mandatory follow-up. Each year, they must do a CT scan or magnetic resonance imaging of the brain, consult an ophthalmologist, gynecologist and endocrinologist, as well as 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 regarding the recovery of patients.