Pituitary adenoma: symptoms, treatment, prognosis, consequences

What it is? Pituitary adenoma is benign in most cases, a slowly growing endocrine system tumor located in the anterior lobe of the pituitary gland and manifested by hypo- or hypersecretion of hormones that are responsible for the regulation of important functions in the human body.

This is a fairly significant medical and social problem, since the vast majority of patients are people of working age: from 30-50 years.

Causes of

At present, there are no clearly established causes for the development of this pathology. It is assumed that this can lead to:

• consequences of craniocerebral injuries;
  
• intoxication;
  
• chronic sinusitis;
  
• infectious processes in the nervous system;
  
• pregnancy and childbirth( pathological);
  
• hormonal imbalance;
  
• continued use of oral contraceptives.

The appearance and growth of a tumor can be a consequence of an internal defect in the pituitary gland, when as a result of a gene disorder of just one cell, a tumor transformation of the gland takes place.

Symptoms of pituitary adenoma

There are several types of pituitary adenoma, separated according to histological features, hormonal activity, growth and location, so the symptoms manifest themselves in a wide range.

The structure of all adenomas often contains hormone-active tumors:

1. 1) Prolactinoma. It is characterized by increased secretion of the hormone prolactin, as a result of which the menstrual cycle is violated in women, up to the development of amenorrhea, milk begins to be produced and released in the absence of pregnancy. In men, testosterone levels drop and spermatogenesis is disturbed, resulting in a weakening of sexual desire, problems with potency and erection. There is an increase in the mammary glands, atrophy of the testicles, a decrease in the vegetation on the face. Because of the leaching of minerals from the bone tissue in both sexes, osteoporosis develops, leading to brittle bones. A tumor can squeeze the optic nerve, so among the symptoms often there is a visual impairment and diplopia. From the side of the nervous system there is a headache, anxiety, nervousness.
   
2. 2) Somatotropinoma. It occurs against the background of increased secretion of growth hormone( somatotropin).It is acromegaly and gigantism. In the first variant, the size of the hands and feet, nose, jaws, and tongue increase in adults. Arthropathies develop and, as a result, pain in the spine, joints. In addition, internal organs suffer, fatigue, disability, headache, which is poorly removed by analgesics. In men, the potency decreases, infertility is noted in women. Gigantism is present more often in men, begins in the puberty period and is characterized by a growth of bones, soft tissues and organs exceeding the physiological limits. After the growth zones are closed( ossification of the epiphyseal cartilage), the pathology passes into acromegaly. Life expectancy is insignificant, the health of such people is weak. They complain of a headache, memory loss, a drop in the level of vision, joint pain and an accelerating rate of growth. There is a disruption in the functioning of the gonads, adrenals and thyroid gland.
   
3. 3) Corticotropin. It is manifested by high secretion of adenocorticotropic hormone and leads to the development of Isenko-Cushing's disease. It often occurs in boys. Expressed dysplastic obesity, trophic skin changes( dryness, peeling, ulcers, stretch marks on the hips in the form of bands), a violation of carbohydrate metabolism. In 90% of cases, there is hypertension, systemic osteoporosis. The decrease in the volume of muscle mass( atrophy) develops, the tonus and muscular strength decrease.
   
4. 4) Thyrotropinoma. This form accounts for only about 2-3% of all occurring adenomas. It leads to the appearance of secondary hyperthyroidism due to increased secretion of thyroid-stimulating hormone.
   
5. 5) Gonadotropinoma. Characterized by increased production of follicle-stimulating and luteinizing hormones. Also a rare form of pituitary adenoma. Most often, hypogonadism is noted, galactorrhea may accompany. Symptomatic is of low specificity, therefore pathology is usually detected in the late stages.

To hormoneally inactive tumors carry the chromophobic adenoma of the pituitary gland, which does not depend on the production of hormones and is manifested as a result of the development of chromophobic adenocytes. It has the property of putting pressure on the nerve endings, which leads to a disruption of the visual and nervous functions. Among the symptoms diagnose headaches, decreased visual field, increased production of thyroid hormones.

Overweight appears, premature aging is noted. Women are disrupted by the menstrual cycle and often this is the first symptom of the disease. In addition to benign adenomas of the pituitary gland, forms can also occur with malignant course, when visual and neurological disorders, symptoms of hypopituitarism, are rapidly growing.

Treatment of pituitary adenoma

The main methods of treatment of pituitary adenomas include:

• medication;
  
• surgical removal of the tumor;
  
• radiotherapy.

All methods can combine, but the leading ones are surgical and medicamentous. In the treatment of medications most often used dopamine agonists, somatostatin analogues, thyreostatics, aminoglutethimide derivatives, ketoconazole, serotonin antagonists.

At low efficiency from medical treatment neurosurgical operative intervention is carried out. There are two possible variants of access - transcranial and transnasal, the choice of each of them depends on the location of the tumor.

Radiation therapy takes place in the event of a patient's refusal to perform a surgical procedure, or if it is not possible to carry it out, but such treatment is fraught with a number of shortcomings. After the operation, the level of hormones immediately decreases and pressure on the structures of the brain is eliminated. When using rays to achieve clinical and biological remission can be spent a lot of time, so this method is considered as an auxiliary option.

For the diagnosis the patient is assigned consultations of the endocrinologist, ophthalmologist, neurosurgeon, oncologist, who specialize in this pathology. After this, an instrumental examination is performed, which includes:

• MRI of the head;
  
• X-ray craniography in two projections;
  
• pneumocisternography;
  
• computed tomography;
  
• microscopic examination of material taken from a biopsy;
  
• cerebral angiography.

To determine the type of tumor, blood and urine tests for hormones are submitted.

Forecast

In most cases, the prognosis depends on the size of the tumor and its hormonal function. The faster the person resorts to the help of specialists, the higher the probability of successful cure.

With adequate therapy and timely treatment, the prognosis is favorable, in other cases the consequences may be irreversible.

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