Scientific editor: Volkov AA, endocrinologist, practical experience since 2015.
September, 2018.
Pituitary adenoma - a group of tumors originating from the part of the brain - adenohypophysis.
Pituitary Adenomas are from 7 to 18% of all intracranial tumors. Most often they occur in the age range 20-50 years (working age), with equal frequency in men and women.
types of adenomas
By the size of pituitary adenomas secrete:
- microadenomas (no change sella dimensions - education in the sphenoid bone marrow, which normally is filled by the pituitary gland)
- small (16-25 mm)
- medium (26-35 mm)
- large (36-59 mm)
- giant (greater than 60 mm).
On hormonal functions:
- hormonally inactive pituitary adenoma
- hormonally active that produces a certain kind of hormone excess, negatively affecting the body work (
- prolaktinoma - produces prolactin,
- kortikotropinomy - produces adrenocorticotropic hormone
- somatotropinoma - produces growth hormone,
- tirotropinoma - an extremely rare tumor, releases thyroid-stimulating hormone,
- gonadotropinoma produces luteinizing hormone LH and / or FSH, follicle-stimulating hormone.
Symptoms of pituitary adenomas
Manifestations of pituitary adenomas depend on the hormonal function of the tumor. If hormonally active adenomas main manifestations - specific hormonal disorders.
The most commonly encountered in clinical practice
- acromegaly (Increase of limb sizes)
- hyperprolactinemia (Decreased libido, infertility, lactation in women, gynecomastia, impotence in men)
- Cushing's disease.
When hormonally inactive adenomas, patients often complain about the violation of (mostly visual field and blurred vision), and headaches.
Rare manifestation of a large pituitary adenoma - a sharp headache, sudden narrowing of fields and drop visual acuity, with involvement of the special part of the brain - the hypothalamus, violations consciousness.
Diagnostics
Examination of a pituitary adenoma: a thorough hormonal and ophthalmologic examination and neuroimaging. To evaluate hormonal status, using blood samples, followed by evaluation of its RIA - radioimmunoassay assess blood hormone.
Determine with the help of content tropic pituitary hormones
- prolactin (265 ug / ml in males, 540 ug / ml in women, 290 ug / ml for women in menopause)
- ACTH (50 pg / ml)
- STG (more than 10 pg / ml)
- TSH (More than 3.8 microns IU / ml)
For neuroimaging used craniography sinuses (x-ray) in direct and lateral projections. With its help assess status of the sella turcica.
Magnetic resonance imaging - the main method of diagnosis allows to identify the size of adenomas less than 5 mm, but even considering this, approximately 25-45% of patients do not visualize adenoma succeed.
CT scans are used only in emergency situations when it is impossible to carry out magnetic resonance imaging in order to avoid serious complications.
CT helps in better visualization of solid bone tissue type. MRI more effective in soft tissue imaging, and therefore it is preferred in cases of suspected adenoma.
Treatment of various types of pituitary adenomas
The main objective of treatment is to remove the tumor or reducing the impact of excess hormones in the body.
Drug therapy includes:
- dopamine agonists (bromocriptine, cabergoline)
- somatostatin analogs (octreotide)
- serotonin antagonists
- Inhibitors of cortisol production
Surgical treatment: transsphenoidal options (the most frequently used at present) and transcranial (when giant suprasellar adenomas) removing tumor.
Radiation therapy is performed as an adjunct therapy.
It should be noted that for each particular type of tumor exists, the most optimal treatment strategy.
It must be remembered that the majority of patients should be treated in specialized medical centers under the supervision of both the endocrinologist, and a neurosurgeon.
More information about operations
Indications for surgical interventions are
- the presence of a tumor,
- its active growth,
- the emergence of pathological changes and other neurological symptoms,
- the emergence of endocrine symptoms that can not be corrected with medication.
No operation is performed to elderly patients, people with chronic heart disease and decompensated stage vessels, renal and hepatic failure, and others.
The method of choice is to remove the majority of adenomas endonozalny endoscopic method. The doctor enters the endoscope and tools to remove through the nasal canal and carries out a resection of the tumor under control of the camera. Depending on the complexity of the case, the operation can take from 60 minutes to 3 hours. Alternative endonasal endoscopic method - transcranial microsurgical operation applied rarely less than 10% of cases).
Rehabilitation hospital after endonasal surgery takes place over 4 days, after which the patient continues recovery at home. After transcranial operations to be in the hospital will have at least 10 days. On average, a full recovery can take up to 2 months.
When endonasal surgery complications are rare. The most serious of them - nose liquorrhea (streaming from his nose CSF). Operation results are assessed essentially as positive.
Radiation therapy is required patients whose tumor was not completely removed or the operation is not possible at all. The problem of radiation therapy - to stop the increase in tumors, slow down the production of hormones pathological. Radiation therapy is carried out using a special apparatus capable of giving strict dosage load. It is the procedure in a hospital.
prolaktinoma
Prolactin treatment is initiated with conservative use of dopamine antagonists. When failure of conservative therapy, surgical intervention. Radiation therapy is only performed if conservative treatment has not given the effect and operation has been performed incompletely (tumor not completely removed). Radiation therapy may continue to stop tumor growth and normalization of hormones.
somatotropinoma
The primary therapy is considered operational. The tumor was removed endoscopically endonasal (through the nasal passages). Conservative therapy may not be constant, it is used only as a means of preparation for surgery, and in the event that intervention has been performed incompletely. After the operation, if it is successful, the patient is under the supervision of a physician. Be sure to performing MRI after 6 months in order to avoid relapse.
kortikotropinomy
The method of choice - removing neoplasms. The cure was observed in 85% of patients.
If there are contraindications for surgery carried drug and / or radiotherapy. After surgery, the patient is under the supervision of a physician. Six months after the intervention performed assessment by MRI.
Contraindications for surgery are e.g.
- old age of the patient,
- presence of chronic diseases in the decompensated stage and others.
Hormonally inactive pituitary adenomas (most macroadenoma)
The method of choice - removal of the tumor. Radiation therapy is conducted in the presence of residual tumor removal inaccessible or inoperable relapse. After surgery, the patient is under the supervision of a physician. Six months after the intervention performed assessment by MRI.
The prognosis of pituitary adenoma
Prognosis depends largely on the size of the tumor (the possibility of its radical removal) and its hormonal function.
When somatotropinomy prolactinoma and "hormonal" recovery is observed in 20-25% of cases, mikrokortikotropinomah - 85% (with tumors larger than 1 cm - much less).
It is believed that the pituitary macroadenomas spread over 2 cm can not be removed completely, so within the next 5 years after surgery, you may experience a relapse.
If successful, the treatment of pituitary adenomas disability is not given. When permanent loss of visual function, the presence of neurological disorders that can not be corrected, you may receive permanent disability.
sources:
- Association of Neurosurgeons of Russia. Surgical treatment of pituitary adenomas. - Clinical guidelines 2014.
