Pituitary adenoma - symptoms, treatment, clinical recommendations

The pituitary gland is an endocrine gland located in the sella turcica (a formation in the human skull). Despite its miniature size, it controls many functions in the body. It is the pituitary gland that produces hormones that are responsible for the functioning of the entire endocrine system. Nature has reliably protected this gland from external influences, but internal factors can still cause pathological changes. One such problem is pituitary adenoma. It can be recognized by hair loss, infertility, changes in appearance, sexual dysfunction and many other signs.

Types of pituitary adenoma

There are various criteria for classifying benign pituitary tumors.

To size:

microadenoma – tumor size up to 10 mm;
mesoadenoma - a tumor measuring from 10 mm to 20 mm, located within the sella turcica;
macroadenoma - a tumor measuring from 10 mm to 30 mm, or extending beyond the boundaries of the sella turcica;
giant adenoma – a tumor larger than 30 mm.

In a simplified classification, meso- and giant adenomas are classified as medium and giant macroadenomas, respectively.

By nature of distribution:

endosellar (intrasellar) – the tumor does not extend beyond the boundaries of the sella turcica;
endosuprasellar - the adenoma grows upward beyond the sella turcica towards the optic chiasm;
endolaterosellar - spread of the neoplasm into the cavernous sinuses by germination of the lateral wall of the sella turcica;
endoinfrasellar – pituitary adenoma grows downwards from the sella turcica.

A tumor growing in different directions is called endo-supra-infra-laterosellar.

By origin:

primary tumors;
secondary, developed as a result of hypofunction of peripheral endocrine glands;
adenomas caused by disruption of the hypothalamus, as well as the production of releasing hormones in ectopic formations located in non-endocrine organs.

Based on hormonal activity, pituitary adenomas are divided into active (about 60% of adenomas) and inactive (about 40%). Hormonally active tumors, based on the type of hormones they produce, are divided into:

somatotropinomas;
corticotropinomas;
thyrotropinomas;
prolactinomas.

Gonadotropinomas are also isolated, which most often do not affect hormonal levels, since they produce biologically inactive hormones. However, sometimes these tumors produce active forms of follicle-stimulating hormone and luteinizing hormone.

There are mixed tumors that produce more than one type of hormones.

Diagnostics

Comprehensive diagnostics is the basis for correct diagnosis. To determine the hormonal status, a blood test is prescribed with an assessment using the RIA method (radioimmune assessment of hormones). The analysis allows you to determine the level of pituitary tropic hormones.

MRI is the main diagnostic method used to detect pituitary adenomas of various sizes. Computed tomography is used less frequently and mainly in cases where it is necessary to visualize hard tissues, the walls of the sella turcica and formations that have spread beyond its boundaries.

CT angiography is one of the most important diagnostic methods performed before planned operations for the removal of large pituitary adenomas. The surgeon must know how the formation is located in relation to the cerebral arteries and optic nerve. Imaging protocols are used directly during surgery.

Dynamic contrast-enhanced magnetic resonance imaging is considered the most informative method for assessing small formations in the pituitary gland. Using a tomograph, you can determine the boundaries and size of the tumor, while ensuring high resolution resolution in the image.

Causes of pathology

The reasons for the development of pituitary adenoma are factors that directly affect the brain and the gland itself (trauma, neuroinfections), as well as those that have an indirect effect due to the pathology of other glands and organs. The latter include disorders of the regulatory function of the hypothalamus, thyroid gland, gonads, as well as the appearance in organs that are not endocrine glands of areas that produce hormones (for example, such accumulations of cells are found in small cell lung cancer).

In hereditary forms of the disease, mutations in suppressor genes that suppress the process of tumor cell changes play a role in the occurrence of tumors. The causes of the mutation are unknownSource: Pituitary adenomas within hereditary syndromes. Mamedova E.O., Przhiyalkovskaya E.G., Pigarova E.A., Mokrysheva N.G., Dzeranova L.K., Tyulpakov A.N. Problems of endocrinology, 2014. p. 51-59.

Clinical picture depending on the type of adenoma

The pituitary gland secretes hormones that affect almost all organs and systems of the human body. Symptoms of active forms of pathology depend on a violation of the degree of production of a particular hormone.

Features of prolactinoma

Prolactinoma is a pituitary adenoma that occurs as a result of changes in the secretion of prolactin. In women, this type of microadenoma manifests itself:

Violation of the cycle
. Patients note a delay in menstruation, a complete absence of menstruation, or, on the contrary, long-term bleeding.
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Infertility
. Pregnancy does not occur in women even in the absence of any gynecological pathologies.
The release of colostrum or milk from the mammary glands
. It occurs in the absence of pregnancy and is usually not accompanied by breast enlargement.
Excessive hair growth
. Hair may appear on the stomach, chest, neck, and face.
Decreased sexual desire
. With a decrease in the amount of prolactin produced, libido decreases sharply.

Prolactinoma is often accompanied by obesity and the appearance of acne on the face.

Symptoms of somatotropinoma

Violation of growth hormone synthesis leads to acromegaly. This disease is primarily characterized by increased thickening and growth of cartilage and bone tissue, which ultimately leads to a noticeable change in appearance:

Hands and feet become enlarged
. Patients often include discomfort when wearing once perfectly suitable shoes as the first signs of the disease.
The appearance of gaps between teeth
. The gaps arise due to the growth of the jaws.
Joint pain
. In advanced cases, the pain syndrome is so severe that the patient is constantly forced to take analgesics, and his independent movement is extremely difficult.
The appearance of rough features in the face
. The lower jaw becomes more massive, protruding brow ridges appear, and the nose increases significantly in size.

Somatotropinomas also lead to weight gain, fatigue and irritability. The disease can lead to decreased libido and persistent hypertension, difficult to control with antihypertensive drugs.

Signs of corticotropin

Pituitary adenomas corticotropinomas alter the synthesis of adrenocorticotropic hormone. This usually leads to the formation of Itsenko-Cushing syndrome, which manifests itself:

Obesity
. Fat is mainly deposited on the stomach or face, causing it to appear moon-shaped. The limbs remain thin, so the patient’s figure looks disproportionate.
Pustular rashes
. They appear in groups on any part of the body.
Stretch marks
. Striae are mainly formed where fat is deposited in large volumes.
Arterial hypertension
. High blood pressure in Cushing's syndrome is difficult to reduce with medications.
Excessive hair growth
. In women, vegetation growth is observed according to the male type.
Osteoporosis
. Increased fragility of bones, even with minor fractures, can cause frequent fractures with minor injuries.
Deterioration of the immune system
. Patients are prone to frequent respiratory diseases and infections.

Corticotropinomas can provoke the development of diabetes mellitus.

Symptoms of thyrotropin

Causes an increase in the level of thyroxine in the blood. Women complain about:

Excessive sweating
. Patients are bothered by profuse sweating even after minor physical exertion.
Irritability
. Emotional instability is noted.
Deterioration of heart function
. Most often it is expressed by tachycardia and interruptions in rhythm.
Weight loss
. Body weight becomes smaller without dieting and sports.
Exophthalmos
. With increased production of thyroxine, the eyes become larger, the eyeball protrudes outward, and a noticeable shine appears.

By losing weight and enlarging their eyes, some women consider themselves more attractive in the early stages of the disease. But this is a dangerous misconception; the appearance of even such changes in appearance should alert you.

Symptoms of pituitary adenoma

Clinical manifestations of the disease can be divided into two groups. With microadenomas or small endosellar tumors, endocrine symptoms come to the fore, varying depending on the hormones secreted.

With large hormonally inactive adenomas spreading beyond the sella turcica, neuro-ophthalmological symptoms prevail, which are different for tumors growing in different directions.

Endocrine symptoms

Somatotropinoma

A tumor that produces somatotropin, or growth hormone. Its manifestations depend on the period of tumor onset. Before the growth of bone tissue is complete (in adolescence and young adulthood), it manifests itself as symptoms of gigantism; in adults, acromegaly.

Gigantism is a proportional increase in bone length and overall height. Women can reach a height of 190 cm, men - over 2 meters.

Acromegaly is characterized by pathological growth of bones, soft tissues, cartilage, and corresponding changes in appearance - the nose, lips, chin, brow ridges, hands, feet increase disproportionately to the rest of the body. Patients experience hyperhidrosis (excessive sweating), hirsutism (excessive hair growth), severe sebum production, and the appearance of papillomas, warts, and nevi on the skin.

In addition, the patient’s internal organs become enlarged, and metabolic and endocrine processes are disrupted. From the cardiovascular system, increased blood pressure, cardiomyopathy, and cerebrovascular accidents are observed. From the nervous system - polyneuropathy, manifested by pain, paresthesia, decreased sensitivity of the peripheral parts of the extremities. The development of obesity, secondary diabetes mellitus, and thyroid pathologies is possible. Source: Main types of complications with pituitary adenomas. K. E. Makhkamov, M. M. Azizov. Bulletin of Emergency Medicine, 2015. p. 90-92.

Corticotropinoma

A pituitary adenoma that produces ACTH is an adenocorticotropic hormone, an excess of which develops Cushing's disease. Its symptoms:

Cushingoid obesity - an increase in the volume of adipose tissue on the face, back, hips and buttocks, and abdomen;
swelling and congestion of the face;
striae - stretch marks of purple-violet color on the skin of the abdomen and thighs;
skin atrophy, especially on the back of the hands, pustular diseases, fungal infections;
osteoporosis accompanied by multiple compression fractures;
arterial hypertension, cardiovascular failure;
secondary diabetes mellitus.

Thyrotropinoma

A neoplasm that produces thyroid-stimulating hormone. Thyrotropinoma can be primary or secondary.

Primary thyrotropinoma has characteristic signs of thyrotoxicosis (excess thyroid secretion). Its symptoms:

cardiopalmus;
tremor - trembling throughout the body, shaking fingers;
hyperhidrosis;
nervousness;
bad dream.

Secondary thyrotropinoma develops as a result of a long course of uncompensated hypothyroidism. It is characterized by:

weakness, lethargy;
body swelling and weight gain;
lethargy, absent-mindedness, memory impairment;
slow metabolism.

Prolactinoma

One of the most common gland tumors. It arises from cells that synthesize the hormone prolactin. The symptoms of this pituitary adenoma are different in women and men. Source: Aggressive pituitary adenomas (literature review and clinical observation). Kalinin P.L., Trunin Yu.Yu., Fomichev D.V., Chernov I.V., Ryzhova M.V. Tumors of the head and neck, 2021. p. 74-80.

Among women:

decreased sexual desire up to frigidity;
menstrual irregularities;
discharge from the nipples outside the period of breastfeeding;
infertility.

For men:

gynecomastia – enlargement of the mammary glands;
hypoplasia of secondary sexual characteristics;
decreased libido, erectile dysfunction;
infertility.

Not long ago, neurosurgeon Vladimir Anatolyevich Zhuravlev gave an interview to the medical portal 103.by and answered questions about pituitary adenomas:

What are the clinical manifestations?
Is there prevention?
What treatment is possible?
Is it possible to conceive and give birth to a child with such a pathology?

The article is available on the portal 103.by, and we also publish it below on our website.

The pituitary gland is a small gland that is located in the head and controls a huge number of body functions. Nature reliably protected him from external influences, but remained powerless against internal changes. Blindness, infertility, sexual dysfunction, hair loss, unpleasant changes in appearance - these are not always the consequences of chronic diseases or negative influences from the outside. Similar problems are often caused by pituitary adenoma.

What it is? What are the first “bells”? How to diagnose the disease and how to treat it? These and other questions are answered by Vladimir Zhuravlev, Candidate of Medical Sciences, Associate Professor of the Department of Neurology and Neurosurgery of the BelMAPO, neurosurgeon of the highest medical category.

-What is the pituitary gland?

— The pituitary gland is the most amazing endocrine gland in our body. It resembles a bean in size and shape, about 15 mm. The pituitary gland is hidden in the most protected place of the head, in the center of the base of the skull, in an isolated bone bed - the sella turcica.

- What are its functions?

- This little “bean” secretes hormones that control all the endocrine glands of our body. His area of responsibility includes metabolism in the body, the formation of the skeleton and muscle mass, growth, and reproductive function. In addition, by controlling the adrenal glands, the pituitary gland ensures an adequate response of the body to all external influences - resistance to stress. In fact, the pituitary gland has much more functions and they all differ depending on the age and physiological periods of life. In childhood, the somatotropic function comes to the fore . From Latin this word is translated as “building the body.” This refers to growth, an increase in muscle mass and other integral changes in the body associated with this process.

During adolescence, hormonal changes occur, called puberty. Secondary sexual characteristics develop. During this period, gonadotropic hormones of the pituitary gland play a particularly important role, regulating the function of the child’s gonads. This is how body type, features of adipose tissue deposition, hair growth and many other features of our body are formed. This formation ends with the body’s ability to produce healthy germ cells or, in other words, the ability to procreate. In general, the gland has a lot of tasks. A failure in its functioning causes serious problems. Just imagine that the processor responsible for the operation of the entire computer system has broken down.

— By what signs can you understand that there are problems with the pituitary gland?

— The first “bells” can be seen by a pediatrician or therapist. During childhood, a child may stop growing. Stunting, especially against the background of the development of other problems - for example, obesity, arterial hypertension, which is not characteristic of age, etc. These symptoms may indicate a dysregulation of the endocrine system. In adulthood, this can manifest itself in changes in a person's physique and appearance, for example:

facial features, fingers and hands, feet, and tongue become larger and larger. These manifestations are symptoms of acromegaly;
the face becomes “moon-shaped”, arms and legs become very thin, and fat is redistributed to the body: to the stomach and chest. Symptoms are characteristic of Itsenko-Cushing's disease;
dryness and thinning of the skin appear, bruising is very easy.
blood pressure rises.

In people over 60 years of age, the clinical picture of pituitary tumors is less clear, and it becomes more difficult to suspect the disease.

As a rule, the average time from the appearance of the first symptoms of pituitary adenoma to diagnosis in adults takes: in women - about 1 year, in men - 6 years. The fact is that one of the first symptoms in young people is sexual dysfunction. For example, a woman’s menstrual cycle is disrupted. In such cases, as a rule, she does not delay and promptly seeks advice from a doctor. If a man’s libido decreases, then not everyone immediately goes to a specialist with complaints of decreased sexual function. In case of problems with conception, the woman is also most often examined first. Although the problem may be male infertility due to dysfunction of the pituitary gland.

— What is a pituitary adenoma?

Benign pituitary adenoma is a whole group of tumors, different in nature, symptoms, course of the disease and prognosis. Pituitary adenomas are the third most common among all intracranial tumors.

They can be divided into two groups:

hormonally inactive (non-secreting hormones);
hormonally active (producing excess amounts of pituitary hormones).

By size they are distinguished:

microadenomas (up to 10 mm);
macroadenomas (more than 10 mm).

The main types of hormonally active pituitary adenomas, depending on what hormone the adenoma produces, are as follows:

prolactinomas - secreting the hormone prolactin;
somatotropinomas - producing somatotropic hormone. The disease is called acromegaly;
thyrotropinomas - secrete thyroid-stimulating hormone. It helps improve thyroid function. The name of the pathology is thyrotoxicosis;
adenocorticotropinomas - produce adrenocorticotropic hormone, which stimulates the adrenal glands. Causes Cushing's disease.

There are also pituitary adenomas that provoke several hormones at once. The most common are hormonally inactive adenomas, which do not produce hormones, and prolactinomas, which produce the hormone prolactin. Their share is approximately 40%.

— What are the clinical manifestations of pituitary adenoma?

— Unfortunately, pituitary adenomas do not have their own characteristic symptoms. Therefore, diagnosing them is quite difficult. Symptoms may include:

headache;
general weakness, decreased blood pressure;
blurred vision, loss of visual fields, decreased acuity;
changes in appearance not related to eating behavior.

The clinical picture of hormonally active pituitary tumors varies depending on the hypersecretion of a particular hormone. Prolactinomas are the most common hormonally active pituitary adenomas. They manifest themselves differently depending on the age and gender of the patient:

women have menstrual irregularities and associated infertility;
in men and women, libido and potency decrease, and infertility is noted;
enlargement of the mammary glands, galactorrhea (spontaneous leakage of milk from the mammary glands without connection with the process of feeding the child).

- For what reasons does such a tumor occur?

— The question has not been fully studied. There is a theory that the problem is a “breakdown” of certain genes. Why this “breakdown” occurs is not completely known to scientists.

— Which doctor can diagnose an adenoma?

“Due to the variety of symptoms, a patient can contact doctors in a dozen specialties. The diagnostic sequence depends on the profile of the specialist to whom the patient turned. If the disease debuts in childhood, pediatricians will encounter the first complaints (short stature). The pituitary gland is an organ that regulates the function of the endocrine system. And therefore, it is most likely that an adult patient will first contact an endocrinologist. And menstrual dysfunction will lead a woman to a gynecologist.

Confirmation of the diagnosis is:

MRI of the brain and pituitary gland;
laboratory diagnostics (study of hormones of the pituitary gland and peripheral endocrine glands);
consultation with an endocrinologist to determine the functional state of the endocrine system and hormonal activity of the adenoma;
examination by an ophthalmologist (examination of visual acuity and fields).

Several doctors also take part in the treatment of pituitary adenomas:

neurosurgeon;
endocrinologist;
ophthalmologist;
and, possibly, doctors of other specialties, for example: gynecologists, oncologists, radiologists.

— What treatment is possible?

The following treatment methods are used:

Surgical removal of the tumor.

At the moment, the most modern and effective is the transsphenoidal endoscopic method of tumor removal (removal is carried out through the nose).

Radiation treatment.

Appointed when:

the operation is impossible. For example, in the presence of absolute contraindications due to heart disease, kidney disease, etc.);
the operation cannot be performed for technical reasons (the location of the tumor and its spread into the neurovascular structures will not allow the tumor to be completely removed);
the previous operation was ineffective (there was no achievement of hormonal compensation after tumor removal).

Treatment options include so-called stereotactic methods, when radiation is applied directly to the tumor, with the most precise focusing, with minimal impact on surrounding tissue. In our country there are the following treatment methods:

radiosurgery (when the entire radiation dose is delivered in one session);
radiotherapy (when treatment is divided into several sessions). Radiosurgical treatment is carried out using a special device called a Gamma Knife.

3. Drug therapy.

Used for prolactinomas. This treatment method allows you to control up to 90% of all prolactinomas. There are medications used for other adenomas, but their prescription is carried out individually in each case by a council of several specialists.

Possible dangers and require treatment:

hormonally active pituitary adenomas;
pituitary adenomas, the size of which exceeds the size of the place from which they originate, that is, these tumors spread to adjacent parts of the brain. They begin to compress the optic nerves (they pass nearby). In this case, vision decreases, which can lead to blindness.

Hormonally inactive adenomas of small sizes (up to 10 mm), detected by chance, most often on MRI during examination for some other reason. They are called "chance finds." There is even a special term for them - incidentaloma. Such tumors, as a rule, do not grow during life, have no symptoms and only require dynamic monitoring. When deciding on the choice of treatment method for pituitary adenoma, a multidisciplinary approach is used (participation of doctors of various specialties). Prognosis for the treatment of pituitary adenoma must be given individually in each specific case.

— Is it possible to give birth to a child with prolactinoma?

- A very important point. The situation called “hyperprolactinemia” should not be confused with prolactinoma. With hyperprolactinemia, there is a lot of the hormone prolactin in the blood, but the cause of this is not a pituitary adenoma. As mentioned earlier, prolactinoma is a hormonally active pituitary adenoma that secretes an excess of the hormone prolactin. An endocrinologist can distinguish between these conditions. How to prescribe adequate treatment. The most informative way to detect tumors is MRI. But the prognosis for restoring fertility in such cases is different. The main symptom of prolactinoma is amenorrhea (lack of menstruation) and infertility. When treated with dopamine agonists, the tumor decreases in size and normal hormonal secretion is restored. Thus, in some cases, it is possible to restore fertility (the ability to become pregnant and give birth). But, unfortunately, this does not always happen, since the regulation of the activity of the endocrine glands is very complex.

— What happens if the pituitary adenoma is not treated?

— As I already said, some types of adenoma do not require treatment at all. In every fourth person on Earth, the pituitary gland has some kind of peculiarity inside it (cysts, seals, scars, zones of atrophy or hyperplasia, microadenomas without hormonal activity, etc.). But health is not always at risk in this case. It happens that a hormonally inactive adenoma is simply present, but does not have any effect on the body. In such cases, periodic monitoring is necessary.

Requires treatment:

Hormonally active pituitary adenomas, which cause hormonal disorders and steadily progress. Therefore, the lack of timely treatment can lead to the development of severe, sometimes fatal complications. For example, with acromegaly, myocardial infarction or stroke may develop due to cardiac dysfunction.
Hormonally inactive macroadenomas, which, when increasing in size, can compress the optic nerves, which can lead to the development of blindness. Unfortunately, such vision loss is irreversible. Compression of other parts of the brain can lead to displacement of the brain inside the skull and the development of hemorrhages or stroke.

By the way. There are tumors with extremely aggressive growth. They need to be treated quickly, using complete surgical removal combined with radiation if possible.

— What types of operations are used to remove pituitary adenomas?

— There are two types of surgical intervention possible:

traditional craniotomy - craniotomy and tumor removal using an operating microscope. This method is used less and less, mainly when the tumor has spread and it is impossible to perform surgery through the nose;
transsphenoidal endoscopic removal. A modern minimally invasive method in which the operation is performed through the nose. About 95% of pituitary adenomas are removed this way today. Today, this method in the world is the most effective, safe, reduces surgery time and facilitates subsequent recovery.

— Are the operations performed under general anesthesia?

- Without fail.

— Are there situations when operations are contraindicated?

— Yes, there are contraindications for operations. Among them:

infectious diseases that are in the active phase. For example, influenza or ARVI also force doctors to postpone surgery;
blood clotting disorder;
uncompensated problems of the cardiovascular system and other internal organs that require correction.

— How long does it take to recover after surgery?

— On average it lasts a month. The patient remains in the hospital for about a week after the operation. Then he goes home, but visits an endocrinologist and neurologist. And also, if necessary, an ophthalmologist and other specialists. As a rule, after surgery, patients continue to lead their previous lifestyle. They return to work and usual activities.

— Is there a way to prevent pituitary adenoma?

— Regarding this problem, the best prevention is self-control. Do not neglect age-appropriate examinations. Regularly monitor your blood sugar levels, blood pressure, and monitor your body weight. Get medical checkups on time. If you feel unwell, do not delay, consult a doctor. Any problem can be solved faster and easier in the early stages.

Be healthy!

Gonadotropinomas

Most often hormonally inactive, they can rarely produce active forms of follicle-stimulating or luteinizing hormones, causing ovarian hyperstimulation syndrome in women.

Neuro-ophthalmological signs

With endosuprasellar adenoma, partial loss of visual fields is observed while maintaining visual acuity. An increase in tumor size leads to gradual atrophy of the optic nerves and blindness.

A tumor growing to the sides causes impaired oculomotor function (ophthalmoplegia) and double vision (diplopia), and decreased visual acuity.

When an adenoma grows into the bottom of the sella turcica, patients note nasal congestion, simulating the clinical picture of sinusitis or nasal tumors.

If the tumor grows towards the hypothalamus, patients complain of sleep disturbances, uncontrolled appetite, unstable thermoregulation (fever, chills), emotional disturbances: unstable mood, tearfulness, irritability.

With a large adenoma and its multidirectional growth, the symptoms will overlap each other and be masked. The following neurological manifestations are possible:

headache, dizziness;
nausea, vomiting;
speech and facial expression disorders;
dysphagia is a swallowing disorder.

Methods for diagnosing pituitary microadenoma

If there are primary signs of the development of a benign pituitary tumor, the patient must undergo a comprehensive examination, the main task of which is to establish the type of microadenoma and detect the factors that provoked the development of the tumor. In most Israeli clinics, the following methods for diagnosing the disease are used today:

the patient is prescribed a comprehensive hormonal profile study;
a complete ophthalmological examination of the patient to identify pathologies of visual function;
Magnetic resonance therapy is prescribed, a procedure performed to directly visualize a pituitary tumor;
computed tomography and x-ray examination.

A study of the patient's hormonal profile involves identifying decreased or increased levels of hormones produced by the pituitary gland. This examination helps to detect hormonally active formations, at a level with the differential diagnosis of the work of other endocrine glands of the body. Israeli doctors use the radioimmunological method for this procedure. Pituitary microadenoma

one of the first to affect the visual function of the body, therefore, in the process of diagnosing the disease, it is often necessary to resort to ophthalmological examinations. This technique allows you to determine the presence of a congestive optic disc, detect a narrowing of the visual fields, and its acuity.

Modern methods for diagnosing adenoma have become possible largely due to the availability of the necessary equipment. X-ray studies and nuclear magnetic resonance imaging make it possible to determine characteristic changes in the location of the pituitary gland and determine the infiltrative level of tumor growth. The presence of additional opportunities and means for examining the patient ensures the accuracy of the diagnosis of the disease.

Diagnosis of the disease

Patients with suspected pituitary adenoma complain to various doctors: a neurologist, ophthalmologist or endocrinologist.

At the initial appointment, the doctor will conduct a general examination, collect an anamnesis of life and illness, prescribe laboratory and instrumental tests: general blood and urine tests, blood biochemistry, ECG. A doctor of appropriate specialization will conduct an ophthalmoscopy, test visual acuity, neurological examination, and evaluate the existing symptoms.

In addition, the following studies are indicated for patients with pituitary adenoma:

radiography of the skull;
CT, MRI of the brain;
Ultrasound of the thyroid gland, heart, liver, spleen;
analysis of hormone levels in blood and saliva.

If surgical intervention is indicated, the patient must consult a neurosurgeon.

Possible complications

Microadenomas grow extremely slowly in size and cause little concern. However, the hyperplasia of their tissues gradually leads to the fact that nearby structures begin to be compressed. As a result, this can cause neurological disorders, including epilepsy and visual impairment. The pathology also manifests itself as headaches, increased blood pressure, weight changes, and decreased libido. All this negatively affects personal life and work, and as a result can lead to psychological problems. The following complications of microadenoma are dangerous:

Cystic degeneration
. The cyst leads to frequent occurrence of severe headaches, to an unreasonable increase in blood pressure, and to mental changes.
Hemorrhage
. Its appearance is indicated by a sharp pain in the head and a sudden deterioration in vision. Hemorrhages most often occur with prolactinomas.

Hemorrhage is a dangerous complication of adenoma, but in most cases it does not lead to death. Cases of self-healing of patients after bleeding in adenoma tissue have been recorded.

Untreated advanced adenoma can lead to blindness

Timely treatment of adenomas that occur with dysfunction of the visual analyzers helps to subsequently restore vision.

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Treatment of the disease

According to clinical guidelines, there are three main approaches to the treatment of pituitary adenoma:

conservative (medicines);
radiation therapy;
neurosurgical.

The drug method is indicated for small prolactin-producing adenomas. Treatment is carried out with prolactin antagonist drugs.

Radiation therapy is carried out in various ways: gamma, proton, external beam radiation therapy, stereotactic radiosurgery.

For somatotropinomas and corticotropinomas, neurosurgical removal is used. Before surgery, hormonal therapy is often prescribed to reduce the effect of hormone hypersecretion, which sometimes leads to a reduction in the size of the tumor. Drug and radiation therapy are also prescribed after surgery according to indications.

Neurosurgical intervention is recommended for macroadenomas that have severe symptoms and a risk of complications - visual impairment, up to complete blindness, hemorrhage, brain cysts. Source: Pituitary adenomas: history, prevalence, clinical picture, diagnosis, treatment. V. P. Syty, A. A. Gonchar, Yu. V. Syty. Problems of health and ecology, 2010. p. 41-50.

Treatment methods used

Standard treatment for pituitary adenoma consists of drug, radiation and neurosurgical therapies. The optimal method of exposure is determined based on the diagnostic results: it depends on the patient’s condition, the characteristics of the tumor itself, and the presence of concomitant diseases.

Drug therapy

Drug therapy is prescribed in 90% of cases. The drugs help get rid of the symptoms of the disease and improve the patient’s well-being. Initially, vitamin and restorative complexes are prescribed. Next, you need to determine the type of tumor:

for prolactinomas, dopamine agonists or ergoline drugs are prescribed,
for somatotropinomas - somatostatin agonists,
for corticotropinoma - steroidogenesis blockers.

If necessary, hormone replacement therapy is performed. If the chosen treatment regimen does not bring results for a long time, then a more radical method of treatment is selected: radiation therapy or surgery.

Radiation therapy

For microadenomas, proton, gamma and remote therapy are used. The essence of the tactic is the introduction of a radioactive substance directly into the pathological area. Thanks to this effect, it is possible to stop the growth of the tumor and achieve regression. Typically, radiation therapy is performed when surgery is not possible and the patient refuses surgery. After such exposure, the pituitary adenoma gradually decreases in size and can be completely destroyed.

Surgical intervention

If the tumor is large and associated complications develop (hemorrhages, cyst formation, visual impairment), its removal using the transcranial method is indicated. The operation involves craniotomy. In some cases, intervention may be performed using endoscopic techniques.

The choice of specific treatment tactics mainly depends on the type of tumor. For prolactinoma, radiation exposure is practically useless, while for corticotropinoma it is highly effective. If the tumor does not cause any disturbances in the body and the patient does not complain of deterioration in health, doctors choose a wait-and-see approach.

Prognosis and rehabilitation

With timely diagnosis and proper treatment, pituitary adenoma has a generally favorable prognosis without undesirable consequences. Remission after removal of an adenoma occurs in 70-80% of cases, this figure is higher for microcorticotropins and lower for somatotropins and prolactin. The relapse rate is about 12%. Postoperative mortality is low - approximately 4%, decreasing to almost 0 for endosellar and endosuprasellar tumors. The risk of mortality is higher with a large adenoma, its penetration into the ventricular system, or tumor growth of blood vessels.

Rehabilitation, as a rule, does not take much time, since most pituitary adenomas are removed transnasally (through the nose) using endoscopic instruments. In the early postoperative period, the patient is prescribed painkillers, hemostatic agents, and antibiotic therapy. If there are no complications, after a few days the patient is discharged home and is under the supervision of a doctor (ENT, ophthalmologist, endocrinologist) in the clinic. No special rehabilitation measures are required.

When should you see a doctor?

Pituitary adenoma is accompanied by endocrine disorders, which always cause negative symptoms. Be sure to make an appointment with your doctor if you experience weight loss or gain without changing your diet, blurred vision, changes in the appearance of the skin, headaches, or sexual dysfunction. You will be prescribed a series of tests, based on which a specialist will make an accurate diagnosis. The sooner you contact a medical clinic, the sooner you will receive a conclusion, the shorter and more effective the treatment will be.

First appointment with a therapist. Next, based on complaints and examination results, the specialist will write a referral to a specialized doctor. Women are examined by a gynecologist-endocrinologist, men by an andrologist. Consultations with doctors of other specializations may be required.

The MedCom clinic in Ryazan has everything necessary for the diagnosis and treatment of pituitary adenoma. Experienced doctors will conduct an emergency examination and develop the most effective and safe treatment regimen. Make an appointment by calling +7 (4912) 77–92–02 or using the online contact form. Do not delay your visit to the doctor - pituitary adenoma can be successfully treated in the early stages!

Prevention

There is no specific prevention of pituitary adenoma, since the exact causes of tumor development are unknown. If suspicious symptoms appear, you should immediately consult a doctor. Timely diagnosis and treatment will help achieve the most favorable results and maintain the patient’s quality of life.

Sources:

The main types of complications from pituitary adenomas. K. E. Makhkamov, M. M. Azizov. Bulletin of Emergency Medicine, 2015. p. 90-92
Pituitary adenomas within hereditary syndromes. Mamedova E.O., Przhiyalkovskaya E.G., Pigarova E.A., Mokrysheva N.G., Dzeranova L.K., Tyulpakov A.N. Problems of endocrinology, 2014. p. 51-59
Aggressive pituitary adenomas (literature review and clinical observation). Kalinin P.L.,
Trunin Yu.Yu., Fomichev D.V., Chernov I.V., Ryzhova M.V. Tumors of the head and neck, 2021. p. 74-80
Pituitary adenomas: history, prevalence, clinical picture, diagnosis, treatment. V. P. Syty, A. A. Gonchar, Yu. V. Syty. Problems of health and ecology, 2010. p. 41-50

Contraindications to surgical treatment

Surgical treatment for pituitary adenoma is in most cases the most effective method. Based on the diagnosis, a tumor removal scheme is developed (open or endoscopic surgery with the choice of optimal access).

Contraindications to radical treatment are:

advanced age;
heart and kidney failure in the stage of decompensation;
diseases of the hematopoietic organs;
untreated infections of any location;
post-infarction and post-stroke conditions;
systemic diseases that occur in severe form.

If surgery is not possible, other methods are prescribed to stop the progression of the pathological process and mitigate the symptoms of the disease.

Forecast of the course of the pathology

Endocrinologists can give a favorable prognosis for microadenomas only with timely detection and treatment of small tumors. If the neoplasm does not manifest itself, then it does not affect the quality of life in any way. Refusal to treat hormonal imbalance or remove a tumor can lead to consequences that are difficult to eliminate.

Normalizing the production of hormones eliminates nervousness, improves metabolic processes, relieves infertility and decreased libido. Surgery for visual dysfunction almost completely restores vision.

Microadenoma is a tumor that is not dangerous in terms of possible lethal outcome. But its development can cause the most undesirable changes for a woman in appearance and mental health. Identification of even minor signs similar to the symptoms of an adenoma should prompt you to consult a doctor for a referral for a comprehensive examination.

Description of the disease

In clinical practice, the disorder refers to both oncological and endocrine abnormalities of the pituitary gland. Despite its prevalence among the population (20% of the total number of adults), it is not possible to reliably identify the main causes of the development of pathology. Some experts tend to classify oncology as a hereditary disease. Some doctors claim that the main factor in its occurrence is past infections in the central nervous system.

Recent research tests indicate the effect of oral contraception on the occurrence of benign and malignant objects in the brain. Provocateurs can be congenital and intrauterine injuries suffered at any age. The majority of recorded formations are harmless, but a certain percentage of cases lead to serious consequences. The danger of a microtumor is determined by its volume and ability to produce secretion.