Pituitary adenoma is the most common tumor disease, accompanied by the formation of a benign neoplasm in this part of the brain. Pathology is detected in 20% of cases. In this case, the disease is almost asymptomatic, therefore, it is diagnosed already in the later stages, and, as a rule, by chance.
Adenoma is a benign neoplasm characterized by slow progression. However, its ability to synthesize hormones leads to serious violations in the work of the whole organism. This explains the presence of alarming symptoms, which manifests itself in the final stages of the disease.
In clinical neurology, pituitary adenoma is divided into:
- hormonally inactive, in which there is no increased production of hormones;
- hormonally active, causing abnormally increased secretion of biologically active substances.
The first type of adenoma is treated by a neurologist, while the second requires the intervention of an endocrinologist. Benign pituitary tumors are divided into groups depending on which hormone caused them to form:
- Prolactinoma is a benign tumor formed from prolactotrophs. A concomitant deviation of this disease is increased production of the hormone prolactin.
- Gonadotropinoma - a neoplasm formed by their gonadotrophs. Accompanied by elevated levels of LH and FSH.
- Somatotropinom. It is formed from somatotrophs and is accompanied by a jump in the rates of somatotropic hormone.
- Corticotropinomy is a benign neoplasm formed from corticotrophs. Accompanied by increased synthesis of ACTH.
- Thyrotropinomy. A tumor of benign nature, formed from thyrotrophs. With this disease, there is an increased production of TSH.
The hormone-inactive pituitary adenomas include oncocytoma and chromophobic adenomas.
Depending on the size, the tumors are divided into:
- picoadenomas having a diameter less than 3 mm;
- microadenomas with a diameter up to 10 mm;
- macroadenomas with a diameter greater than 10 mm;
- giant adenomas - from 40 mm.
Depending on the direction of growth, adenomas are:
- endosellar (the tumor is localized in the cavity of the Turkish saddle);
- infrasellar (the tumor grows downwards, reaching the sphenoid sinus);
- suprasellar (adenoma grows up);
- retrosellar (tumor grows posteriorly);
- lateral - spread to the sides;
- anecellar - adenoma grows anteriorly.
If the tumor grows in different directions, it is classified according to the direction in which it grows.
Causes of development
The causes of the disease are not fully established, but there are several hypotheses of its development:
- Internal defects. According to this theory, when a gene is damaged in one of the pituitary cells, its transformation into a tumor is triggered, which then begins to grow.
- Violation of the hormone-producing functions of the pituitary gland. The amount of hormones produced is regulated by statins and liberins. Against the background of a decrease in the former and an increase in the latter, hyperplasia of the glandular pituitary structures develops. This is the root cause of the development of the tumor process.
The risk group includes people:
- suffering from neuroinfections (polio, encephalitis, meningitis, etc.);
- undergoing a course of hormone therapy (especially for women who have been using COC for a long time).
The adverse course of the gestational period with mechanical impact (trauma) on the fetus may in the future lead to the development of this disease, both in childhood and in adulthood. Despite the fact that pituitary adenoma is a benign neoplasm, some of its varieties may eventually degenerate into cancer.
The features of the manifestation of adenoma depend on the type of tumor and the hormones produced by it. Also, the symptoms of pituitary adenoma can manifest themselves in ophthalmic-neurological or endocrine-metabolic syndromes. Perhaps the occurrence of X-ray symptoms of neoplasia.
Thus, the development of ophthalmic-neurological syndrome occurs at a time when the tumor begins to grow in size. When squeezing the surrounding tissue, the adenoma can cause the patient to feel unwell in the form of headaches, double vision, as well as decrease, partial or complete loss of vision.
Cephalgia is often blunt, local in nature, and its source is located either in the temporal or in the frontal part of the head. As a rule, taking analgesics gives a short-term effect, or does not bring relief at all.
Visual disorders are observed with large-sized adenomas. In this case, the tumor compresses the optic nerves and their intersection. With adenomas of diameters of 1-2 cm, nerve atrophy may occur, resulting in complete blindness.
The cause of the endocrine-exchange syndrome are changes in the process of producing pituitary hormones. And since this part of the brain regulates the work of the peripheral glands, with adenoma their hyperactivity develops.
Prolactinoma is the most common type of adenoma among women. It is caused by hypersecretion of the hormone prolactin, and is manifested by the following symptoms:
- disruptions in the menstrual cycle up to amenorrhea - complete cessation of menstruation;
- white nipple discharge;
- secondary infertility;
- sharp weight gain;
- hirsutism (male body hair growth);
- decrease in sexual desire.
Prolactinoma occurs in men, and they are more likely to suffer from ophthalmic-neurotic syndrome. To the main signs join discharge from the nipples, impotence, an increase in the mammary glands.
For comparison: in men it is much more difficult to suspect prolactin than in women. In male patients, only sexual disorders are clearly manifested, which the patient himself does not associate with a pituitary tumor. Therefore, adenoma in this case is detected in the late stages of its development. In women, the disease can be detected even at the stage of microadenoma.
With this pituitary tumor, there is an increased production of ACTH, which affects the adrenal cortex. Due to hypercortisolism, patients develop symptoms in the form of:
- significant weight gain;
- the appearance of age spots on the skin;
- the formation of stretch marks (stretch marks) on the abdomen and hips;
- hirsutism in women;
- increased hairiness in men;
- mental disorders.
The above symptoms form a clinical picture of Itsenko-Cushing's disease. It is the corticotropinomas that are more prone to malignancy than other adenohypophysis tumors.
Somatotropic adenoma is accompanied by hypersecretion of somatropin, a growth hormone. It is his excess in the children's organism that causes such a deviation as gigantism. In adults, acromegaly often develops on this background.
When gigantism is observed rapid growth of the whole body. Patients with this deviation are distinguished by their height, long arms and legs. But this is not the worst. The fact is that with gigantism, the functioning of the internal organs is disturbed due to the active growth of the body and the creation of an increased load on the whole organism.
Acromegaly is characterized by an increase in only certain areas of the body - the hands or feet, or the face. At the same time, the height of a person remains normal, normal.
Growth hormones are often accompanied by the development of diabetes, obesity and thyroid disease.
Thyrotropinoma is one of the most rare types of pituitary adenoma. It produces false thyroid hormones, resulting in the development of thyrotoxicosis. This deviation is characterized by sudden irregular weight loss, general malaise, bouts of heat, dizziness, nausea, headaches, etc.
When gonadotropinoma occurs, an uncontrolled synthesis of hormones occurs, under the influence of which the gonads are stimulated. However, the clinical picture with this type of adenoma remains blurred. As a rule, it is a manifestation of sexual disorders, infertility or impotence (in men). If we talk about the other symptoms of gonadotropinomas, then it most often manifests itself in ophthalmic-neurological disorders.
Large adenomas of the pituitary gland provoke compression of not only the nervous structures, but also the parenchyma of the endocrine gland itself. The consequence of this is a violation of hormone-producing functions.
Against the background of reduced secretion of biologically active substances, weakness occurs, rapid fatigue, a decrease in the rate of metabolic processes in the body, which leads to obesity. Insufficient production of adenohypophysial hormones is called hypopituitarism.
Despite such a wide variety of clinical picture, the diagnosis of pituitary adenoma is a rather complicated process. This is explained, first of all, by the absence of specific signs that would indicate precisely this disease. Therefore, the patient's referral to highly specialized specialists rarely helps to identify pathology. But when a patient is diagnosed with adenoma, the patient must be monitored by several doctors at once.
Previously, the most reliable method of diagnosis was radiography of the Turkish saddle. But those abnormalities that are detected with its help, appear already in the later stages of the adenoma. But for early diagnosis, it is more expedient to carry out an MRI or CT scan of the brain. However, even this procedure may be unsuccessful if we are talking about some types of microadenomas.
Another important diagnostic measure is the study of venous blood for pituitary hormones. Elevated or reduced levels of certain biologically active substances can help in making a diagnosis.
Treatment of pituitary adenoma
Treatment of pituitary adenoma depends on its type, location and size. To begin with, the patient is carefully monitored. The physician should monitor the dynamics of the development of the neoplasm, assess the risk of complications and record the intensity of tumor growth.
If the neoplasm has a tendency to increase, and at the same time the patient’s well-being deteriorates, the decision is made to immediately take certain therapeutic measures. In the absence of complications, monitoring of the patient continues.
Such therapy is prescribed mainly to patients with prolactinoma or somatotropinoma. Drug treatment is based on the use of drugs that block the production of hormones. Due to this, it is possible to normalize the hormonal background and restore the physical and psychological state of the patient.
Radiosurgical treatment of adenoma involves the destruction of the tumor using radiobeam. This is a highly effective modern method of instrumental therapy, used in various tumor pathologies.
Surgical excision of the tumor
Surgery to remove the pituitary adenoma is an intervention, the advantage of which is high efficiency. Minus - a great risk of trauma to the brain tissue during excision of the tumor. Small neoplasms are removed through the nose, but for large adenomas, or when they are located in difficult-to-reach areas of the GM, an “open” operation is performed to excise the adenoma.
Often, to achieve the desired result, doctors combine several therapeutic techniques at once. The whole process is controlled by a specialist, so there is no self-treatment in this case!
Complications of pituitary adenoma without surgery
With a rapidly increasing adenoma, which was treated with conservative methods, atrophy of the optic nerve is possible, leading to visual impairment and complete blindness. This, in turn, entails patient disability.
Sometimes there is a hemorrhage in the pituitary tissue with subsequent apoplexy and acute loss of vision. But in the overwhelming majority of cases, untreated pituitary adenoma, in both men and women, leads to infertility.
Pituitary adenoma is a benign neoplasm, but if untreated, it can malignantly. However, timely diagnosis of the disease makes it possible to completely remove the tumor without complicating the patient's health. Although the possibility of complete excision of adenoma directly depends on its size.
The prognosis also depends on the type of adenoma. With microscopic corticotropinomas in 85% of cases, complete restoration of vision occurs after surgical removal of the tumor. But with somatotropinoma and prolactinoma, such a favorable outcome is observed only in 20-25% of cases, respectively. But it is interesting that often hemorrhages that occur during prolactinoma go through a self-healing phase and do not cause significant harm to human health.