Pituitary adenoma: Symptoms, Causes and Treatment

Pituitary adenoma is a benign neoplasm of the nature, in the formation of cells which are involved adenohypophysis (anterior pituitary region) responsible for maintaining the hormone balance in the body at the desired level.

Adenomas, which is the place of formation of the skull base, around 10% of all tumors affecting brain tissue, and only inferior superiority gliomas and meningiomas.

According to statistical figures, about a third of the population is subject to various pathologies of the pituitary.

Causes of

What it is? To date, the medicine does not indicate the exact reasons that may cause pituitary adenoma. But there are several factors contributing to the emergence of hypertension:

• traumatic brain injury;
• the unborn fetus;
• various CNS - such as encephalitis, meningitis, Polio, brucellosis, Neurosyphilis, tuberculosis, cephalopyosis;
• according to some dangerous long-term use of oral contraceptives.

All causes of pituitary adenomas can be grouped according to their investigation - they all cause hyperplasia (excessive cell reproduction) pituitary tissue due to hormonal imbalance.

What are the adenoma?

Hormonally active tumors, depending on hormones produced by them, are of the following types:

1. Prolactinoma (prolactin generates, causes the formation of milk).
2. Mixed adenoma (produce several hormones simultaneously).
3. Gonadotropic adenoma (produces hormones that stimulate the gonads work: follicle stimulating and luteinizing hormone).
4. Tireotropinoma (produces thyroid hormone, which controls the thyroid gland work).
5. Kortikotropinomy (synthesizes adrenocorticotropic hormone responsible for the production of adrenal glucocorticoids).
6. Somatotropinoma (allocates somatotropic hormone responsible for growth of the organism, protein synthesis, breakdown of fats and glucose formation).

Depending on the size of the tumor, all pituitary adenomas are divided into micro and macroadenoma. Microadenomas can not be detected even with MRI, and periodically detected during autopsy, which are held on the occasion of an entirely different disease.

Also depending on its constituent cells, adenoma may be hormonally active and inactive (60% and 40%, respectively). In turn, almost all hormonally active adenomas produce any one hormone of the anterior pituitary, and 10% of tumors - several hormones.

Symptoms of pituitary adenomas

Clinically manifest pituitary adenoma complex ophthalmo-neurological symptoms associated with the pressure of the growing tumor intracranial structures disposed in sella. If the pituitary adenoma is a hormonally active, in her clinical picture in the foreground can go endocrine and metabolic syndrome.

The changes in the patient's condition often associated not with the hyperproduction tropic pituitary hormone, as with the activation of the target organ to which it operates. Manifestations of endocrine and metabolic syndrome is directly dependent on the nature of the tumor. On the other hand, pituitary adenoma can be accompanied by symptoms panhypopituitarism, which develops due to destruction of the growing pituitary tumor tissue.

Somatotropinoma is 20 - 25% of the total pituitary adenomas. In children, frequency of occurrence is the third largest after prolactinoma and kortikotropinomy. It characterized by elevated levels of the hormone in the blood increase. Signs somatotropinomy:

• If somatotropinoma emerged into adulthood, she manifested symptoms of acromegaly - an increase in the hands, feet, ears, nose, tongue, change and coarsening of facial features, the appearance of increased body hair, facial hair in women, menstrual disorders cycle. The increase in internal organs leads to disruption of their functions.
• The children shown symptoms of gigantism. The child quickly gains weight and growth, which is due to uniform growth of bones in length and width, as well as the growth of cartilage and soft tissue. As a rule, gigantism begins in the prepubertal period, some time before the beginning of puberty and can progress until the end of the formation of the skeleton (about 25 years). Gigantism considered to increase adult height 2 - 2.05 m.

Prolactinoma. The most common pituitary tumor, occurs in 30 -40% of all adenomas. Typically, prolactinoma dimensions do not exceed 2 - 3 mm. In women it is more common than in men. It manifests such features as:

• galactorrhea - constant or periodic allocation breast milk (colostrum) from the mammary glands, is not associated with the puerperium.
• the inability to get pregnant due to lack of ovulation.
• menstrual disorders in women - irregular cycles, the elongation cycle of 40 days, anovulatory cycles, absence of menstruation.
• prolactinoma in men manifests reduced potency, breast enlargement, erectile dysfunction, a violation of sperm production, leading to infertility.

Kortikotropinomy. It occurs in 7 - 10% of pituitary adenomas. Is characterized by excessive production of adrenal hormones (glucocorticoids), this is called Cushing's disease - Cushing.

Signs kortikotropinomy:

• skin disorders - stretching pink - purple (striae) on the skin of the abdomen, breasts, thighs; enhanced pigmentation of the skin elbows, knees, armpits; Increased dryness and peeling skin.
• "Cushingoid" type of obesity - the redistribution of body fat and fat deposits in the area of ​​the shoulder girdle, in the neck, supraclavicular areas. A person acquires a "crescent-shaped", round shape. Limbs become thinner due to atrophic processes in the subcutaneous tissue and muscles.
• arterial hypertension.
• in men is often a decrease in potency.
• women are menstrual irregularities and hirsutism - increased hairiness of the skin, the growth of facial hair.

Gonadotropinoma as tireotropinomy, as well as the previous version of pituitary adenomas, have been reported in patients is extremely rare. Manifestations of endocrine-exchange factor determined by the nature of the primary tumor or the development of them on the background long flowing lesions affecting the iron-target (e.g., hypothyroidism or hypogonadism). Tireotropinomy primary provoke thyrotoxicosis, thyrotropin detecting the secondary current occurs against hypothyroidism.

Gonadotropinoma often accompanied by hypogonadism in women (which is manifested in the form of reduced ovarian function or complete cessation in combination with amenorrhea and a variety of menstrual disorders) and men (reduction of the sex glands and the functions of another kind relevant to this condition violations). Diagnosing gonadotropin usually occurs as a result of comparison oftalmonevrologicheskoy symptom (manifestation character endocrine tumors with this embodiment, not They are specific).

Independent of tumor hormone. To this species belongs chromophobe pituitary adenoma. Signs indicating the possibility of its presence:

• headache;
• women is a violation of the menstrual cycle;
• may appear overweight;
• visual impairment due to the fact that the tumor exerts pressure on the optic nerves;
• the level of hormones, which produces thyroid gland, may rise;
• there is a premature aging.

Most of these tumors are discovered by chance when a patient undergoes an MRI-exam. Treatment of this type of pituitary adenoma surgery alone. It can be used radiotherapy. Drug treatment is used only in combination with other species. Itself the result of it does not. In addition, very often accidentally discovered a tumor that does not depend on hormones, does not grow. Therefore it does not require the intervention of doctors. They leave such adenoma under constant surveillance. If it starts its growth, it is likely that in this case it will be necessary to use a surgical method.

Endocrine disorders pituitary adenoma

The consequence of pituitary adenoma may be different dangerous endocrine diseases.

The most common:

• hyperprolactinemia;
• Cushing - Cushing's disease;
• acromegaly and gigantism.

Hyperprolactinemia occurs in patients with pituitary prolactinoma. This disease is better than the other responds to conservative treatment. The operation is most often not necessary.

The cause of acromegaly and gigantism are acidophilic pituitary tumor, called somatotropinomy. There are medications to suppress the disease. However, radiation therapy and surgical removal are more effective methods of treatment.

Cushing's disease is caused by a tumor of the pituitary basophilic. This is called the neoplasm kortikotropinomy. The most effective treatment is considered surgical removal.

Diagnostics

If your symptoms is carried out:

• MRI or CT (visualization of the endocrine glands);
• endocrinologist examination (determination of hormonal status);
• oculist examination (perimetry checking visual acuity, ophthalmoscopy);
• craniography sella for the presence of specific osteoporosis and bypass the bottom.

Diagnosis is based on:

• increase sella (presence craniopharyngioma, squeezing or third ventricular tumors).
• loss of visual function (presence chiasm glioma).
• presence of endocrine disorders and primary endocrine disease (adrenal tumors, diseases of endocrine glands, etc.).

After clarifying the nature of hormonal research needs of the patient transfer to specialized centers or clinics with sufficient experience. This is due to the fact that the definition of hormonal status without physiological effects often does not give objective information about the disease.

How to treat a pituitary adenoma?

In modern medicine, the treatment of pituitary adenomas in men and women is made using drug, radiation and surgical therapies. In each case, for each of the varieties of pituitary tumors, in accordance with the flow step and its characteristic dimensions selected individual treatment option.

Conservative treatment

Drug treatment is usually given at small sizes of tumors and only after thorough examination of the patient. If a tumor lacks the corresponding receptors, the conservative therapy will have no effect and the only output radiation becomes operative or tumor removal.

1. Drug therapy is justified only when the small size and the absence of signs of neoplasias visual disorders. If the tumor is large, then it is performed before surgery to improve patient's condition prior to surgery or after it as replacement therapy.
2. The most effective treatment is considered by prolactin-producing hormone prolactin in large quantities. Prescriptions from the group Dofaminomimetiki (Parlodelum, cabergoline) provides good therapeutic effect and even eliminates the need for surgery. Cabergoline is considered to be a new generation drug, it can not only reduce the overproduction of prolactin and tumor size, but also to restore sexual function and semen parameters in men with minimal side effects. Conservative treatment is possible in the absence of progressive visual impairment, and if it is held a young woman planning a pregnancy, the administration of drugs is not an obstacle.

In the case of tumors somatotropic somatostatin analogues used, administered in thyrotoxicosis tireostatiki, while Cushing's disease provoked by a pituitary adenoma, effective derivatives aminoglutethimide. It is worth noting that in the last two cases, drug therapy may not be constant, and serves only as a preparatory stage for a subsequent operation.

Surgery

one of the two methods can be used for surgical removal of adenomas:

1. Transcranial - implying conduct craniotomy.
2. Transfenoidalny - through the nasal cavity.

If diagnosed and microadenomas macroadenoma that do not have a serious impact on the surrounding tissue, surgery is performed by transfenoidalnym. If the tumor reaches a huge size (10 cm in diameter) is recommended only transcranial removal.

Transfenoidalnoe removal of the adenoma is allowed to do, when the tumor is confined to the Turkish saddle or goes beyond it by no more than 2 cm. It is performed in a hospital after consultation with a neurosurgeon. The introduction of endoscopic equipment is carried out under general anesthesia. The fiber optic endoscope is introduced to the anterior cranial fossa through the right nostril. Next to free access to the area of ​​sella made an incision wall of the sphenoid bone. Pituitary adenoma was excised and removed.

All surgical procedures are performed under an endoscope, an enlarged image of the current process displayed on the monitor, so that the neurosurgeon becomes available with a broad overview of the operational field. The operation lasts about two to three hours. On the first day after surgery, the patient may already be active and on the 4th day - completely discharged from the hospital with no complications. In 95% of cases, this operation pituitary adenoma cured completely.

Transcranial operation is carried out in the most severe cases, under general anesthesia through craniotomy. High trauma and the risk of complications forced neurosurgeons to take this step only if inability to use the method of endoscopic removal of the adenoma, such as when the tumor grows inside tissues brain.

forecast treatment

Pituitary adenomas are benign nature, but with the active growth they can deliver a lot of problems and even degenerate into a malignant process.

If the tumor is large (more than 2 cm), the great risk of recurrence within 5 years after surgical removal.

Equally important in the prediction of such entities has the character of an adenoma. For example, when somatotropinomy prolactinoma or a quarter of patients there is a complete recovery of the endocrine activity, with mikrokortikotropinomah 85% of patients recover completely.

The average recurrence rate is around 12%, and ends with recovery of 65-67% of cases. But these forecasts are justified only with timely treatment to the narrow specialists.