Pituitary adenoma. Microadenoma of the pituitary gland. Prolactinoma - Causes, symptoms and treatment. MF.
Pituitary adenomas most often arise from the cells of the anterior lobe of the pituitary gland, responsible for the production of hormones that regulate many important functions of the body. These tumors are detected with a frequency of 2 people per 100 000 population, but their true prevalence is difficult to establish,many of them are asymptomatic for a long time.
Symptoms of adenomas and microadenomas of the pituitary gland
Symptoms of adenomas of the pituitary gland consist of endocrinological disorders and symptoms of compression of the normal pituitary gland and adjacent brain structures. Symptoms of compression are manifested by headache, sometimes by epileptic attacks, disturbances of severity and narrowing of the visual fields, as well as by violation of eye movement.
Endocrinological disorders may vary depending on the type of hormonal activity of the tumor. The most common tumor, detected in 40% of cases, is prolactinoma .In the case of prolactin in addition to the symptoms of compression, women experience irregularities in the menstrual cycle, amenorrhea( absence of menstruation), discharge of colostrum from mammary glands( galactorrhea), in men and women - infertility.
Tumors that do not produce hormones disrupt their formation in the normal pituitary, which leads to a decrease in their level in the body.
The main diagnostic method is MRI, which allows to detect the tumor, as well as to assess its position in the Turkish saddle and the relationship with the surrounding structures of the brain, primarily the chiasma and optic nerves. In the case of inaccessibility of MRI in case of suspected adenoma of the pituitary gland, an x-ray of the head with an eye on the Turkish saddle, examination of the visual fields is used. When suppressing hyperprolactinemia, they pass an analysis to the hormone of the pituitary gland of prolactin. An additional study is needed on thyroid hormones, since adenomas and pituitary microenadomas producing prolactin often appear against the backdrop of a prolonged current hypoteriosis.
Treatment of adenomas and microadenomas of the pituitary gland
Methods of treatment of adenomas of the pituitary gland can be medicamentous, surgical and radial. The decision on this or that method of treatment of the pituitary adenoma is taken individually for each patient. Some tumors( eg, prolactinoma) can be treated with medication.
Surgical methods for treating adenomas of the pituitary gland are divided into transcranial( with trepanation of the skull) and transsphenoidal( with access through the main sinus).Radiation therapy is used as an adjunct to surgical treatment in case of not completely removed tumors to prevent their recurrence.
Radiosurgery is an effective method of treating small adenomas of the pituitary gland( the largest diameter of which does not exceed 30 mm).According to existing worldwide standards, the Gamma Knife should be used to treat residual tumors after surgical removal. At the same time, radiosurgery can be a method of treating both hormonal-active and inactive tumors. This method of treatment is particularly shown in the spread of adenoma to the cavernous sinus. Necessary to prevent further growth of the tumor, the dose of radiation is delivered once, without affecting the surrounding structures of the brain, with an accuracy of only available Gamma Knife( 0.5 mm).Radiosurgery is also used to treat relapse with adenomas after radiation therapy. As a primary treatment for adenomas of the pituitary gland, radiosurgery is used only if the patient refuses to perform the operation or is unable to perform due to the patient's condition.
The aim of radiosurgery is to achieve control of the tumor( stabilization in size or decrease) and normalization of endocrine disorders, which relieves the patient from the need for prolonged( sometimes lifelong) intake of drugs.
The advantages of radiosurgery are the absence of surgical complications, as well as the risk of general anesthesia. Lethality in the treatment of Gamma Knife is zero. Hospitalization in the vast majority of cases is not required. Treatment is carried out in one day. Most patients return to their usual activity the day after the operation.