A pituitary tumor or a pituitary adenoma is a benign tumor that usually appears on the anterior side of the pituitary gland.
The Place And Functions Of Pituitary
The pituitary gland is located just behind the nose and eyes in a pocket called sella tursika (Turkish funnel), and is a chickpea-sized special gland that connects to the brain with a stalk and allows the hormones to be secreted and balanced in the body. Although the weight of the pituitary gland is less than 1 gram, it has important functions in the secretion and control of many hormones.
What Is Hypofized Tumor, In Whom Is Seen?
A pituitary tumor or a pituitary adenoma is a benign tumor that usually appears on the anterior side of the pituitary gland. Pituitary tumors constitute approximately 15% of primary brain tumors. Although it is seen in all age groups, it is more common in 30-60 age group. It is the third most common primary brain tumor after meningiomas and gliomas in adults. Although its exact frequency is not known, it is thought to be a pituitary tumor that does not show any symptoms in the community by about 25%.
Prolactin, growth hormone and adrenocorticotropic hormones are secreted from this gland. These hormones help many important functions in the body such as sexual development, bone development, muscle building, stress coping and protection from diseases. Pituitary tumors disrupt this normal hormonal functioning. Some pituitary tumors do not release hormones. Tumors that are usually hormone-efficient are more common in young people and tumors that do not have any hormone effect occur in older ages.
Patients with a pituitary gland may not show any symptoms of this condition or symptoms that are not related to the tumor may be seen. Some of the symptoms that can be seen in people with pituitary gland tumors include:
- Vision disorders
- Menstruation changes in women
- Problems of sexual impotence in men due to hormonal changes
- Too little or too much breast milk production
- Cushing syndrome due to excess ACTH (adrenocorticotropic hormone) production
- Acromegaly caused by excessive growth hormone production (thickening and growth in the bones and the sharp points of the body after the general development has ended)
- Reasonable fatigue
- Inconsistency of mood
Symptoms Based On Type And Features
There are many different types of pituitary tumors. Depending on the type and characteristics, the symptoms also change. Pituitary tumors with a size less than 10 mm are called microadenoma, and those with a size of 10 mm are also called macroadenoma.
Prolactin-secreting pituitary tumors: The most common pituitary tumor, prolactinoma, is most common in women of reproductive age and constitute for approximately 30-40% of all pituitary tumors. This tumor secretes prolactin, a hormone that controls sexual function. As a result of this excessive prolactin secretion, it can be seen that women can stop monthly menstrual bleeding, and / or the start of milk production in the breasts. These tumors, which can be seen in men between 40 and 50 years of age, may cause symptoms such as headache, vision loss, impotence or sexual reluctance. Most of these tumors are microadenomas.
Pituitary tumors secreting growth hormone: Growth hormone-secreting pituitary tumors, mostly in men, constitute for approximately 20% of all pituitary tumors. These tumors, which are usually macroadenoma, cause deviation in children or adolescents, They may be the cause of acromegaly in adults who have completed growth. Acromegaly is the growth of hands, feet and chin. In addition, excessive growth hormone secretion can aggravate high blood pressure, heart disease and diabetes.
Adrenocorticotropic hormone (ACTH) secreting pituitary tumors: ACTH-secreting pituitary tumors, which constitute approximately 14% of all brain tumors, are more common in women. The ACTH hormone stimulates the secretory glands of the body, allowing the release of natural steroids, that is, glucocorticoids. Excessive secretion of glucocorticoids causes Cushing's disease. Symptoms of this disease include weight gain, diabetes, menstrual dysfunction, excessive hair in the body, bruising of the skin and high blood pressure.
Pituitary tumors that do not secrete any hormones: These tumors, which constitute approximately 25% of all pituitary adenomas, usually reach large sizes without symptoms. This growth may cause loss of vision and headache. The compression of the tumor may also prevent the secretion of hormones normally released from the pituitary. This may cause symptoms such as indifference, malaise, fatigue and pallor on the skin. Blank cell adenomas, oncocytomas, silent corticotroph adenomas and gonadotropic adenomas are the tumors in this group.
Other hormone-secreting pituitary tumors: These tumors constitute less than 1% of all pituitary tumors. These tumors are secretes by hormones that cause excessive secretion of thyroid hormone, feminine (ovarian hormones) or masculine (testis hormones) hormones.
Pituitary cancers: The real malignant tumors of the pituitary tissue are not usually found. Pituitary carcinoma is the name given to tumors that start in the pituitary and then metastasize to the brain or outside of the central nervous system. These rare tumors are usually treatment-resistant macroadenomas. They tend to repeat and spread to the spinal cord or other organs.
When a physician suspects a pituitary tumor, a physician examines hormone levels in the blood by asking for a series of blood tests following a physical examination and neurological examination. Skull films and medicated MRI are used to examine pituitary and sella tursica. In addition, consultation with other specialist physicians (an endocrinologist and ophthalmologist interested in hormonal diseases) may be requested.
Active follow up: Patients who have not had any pituitary gland problem and who process hormones in a normal way can benefit from active follow-up treatment. In the active monitoring method, the patient is followed closely and tests are performed regularly. Thus, it is examined whether there are any signs of tumor. Therefore, this type of treatment is also called a watchful-waiting approach. Treatment is started when tumor symptoms are observed.
Hormone Replacement Therapy (HRT): If the pituitary gland does not produce enough hormones because of the pituitary tumor, hormone replacement therapy becomes unavoidable. Some hormones are transformed to provide the hormones that your body needs. Hormones secreted by the adrenal glands, thyroid hormones, estrogen in women and hormones testosterone and growth hormone in men are needed hormones.
Medication treatment : If pituitary tumor causes the pituitary gland to produce more hormones, the drugs will help patients. Tumors that cause overgrowth of growth hormone can be treated with Somavert (pegvisomant) or Sandostatin (octreotide), whereas Dostinex (cabergoline) and Parlodel (bromocriptine) are excellent drugs for secreting prolactin. Thyroid Stimulating Hormone (TSH) secreting pituitary tumors can also be treated with octreotide.
Surgical intervention: Surgical intervention is the most common treatment for pituitary gland tumors. Helps to remove the tumor completely and successfully. Surgical intervention involves removal of the tumor and tissues around the tumor by an operation. In more than 95% of surgical interventions, a transsphenoid path is used, while in some cases a skull opening or craniotomy is required. During transsphenoidal surgery, it is inserted through the nasal passage and progressed along the septum through the sphenoid sinus cavity. Since the pituitary gland is located behind the throat, it must reach the back of the throat.
Radiation Therapy The use of X-rays to eliminate tumor cells is radiation therapy. Radiation oncologist is the title given to doctors who specialize in applying radiation therapy to tumor patients. External-beam radiation therapy is one of the most common radiation-treated methods in which the body is treated by receiving radiation from an outside machine. The duration of radiation therapy is usually given in the form of a series of treatments in a period to form a treatment number.