Pituitary tumors, as the name implies, are tumors of the pituitary gland, an important endocrine organ of the human body located in the skull and known as the “king of glands”, which secretes many important hormones for maintaining various vital functions of the human body. Pituitary tumors are divided into functional pituitary adenomas and non-functional pituitary adenomas. The former may have one or more pituitary hormone abnormalities, such as gigantism, acromegaly, amenorrhea, lactation, decreased sexual function, centripetal obesity or fear of heat, etc. The latter usually has none of the above symptoms, but usually the first symptom is loss of vision or headache. When the pituitary tumor affects the pituitary stalk, symptoms of urinary collapse and polyuria will appear, which should be distinguished from diabetes.
Pituitary tumors have a huge impact on the body and therefore must be treated. If the tumor does not compress the optic nerve and is less than 3 cm in diameter, it can be treated directly with Gamma Knife. Simple prolactinomas can also be treated with oral dopamine agonists, such as bromocriptine. Other cases of pituitary tumors generally require surgery, which is generally classified as transnasal or open surgery. Transnasal pituitary tumor resection is less invasive, has a mild postoperative response, and has a shorter hospitalization period, which is highly preferred by patients and doctors, but it is not suitable for all patients. If the tumor is mainly suprasellar lesion, other lesions in the nasal cavity or butterfly sinus, or abnormally developed nasal base or intercavernous sinus, it is not suitable for transnasal surgery, and it is wise to choose craniotomy.
Modern microscopic techniques are exceptionally developed, and the mortality and disability rates of pituitary tumor surgery have decreased significantly. Postoperatively, some patients may develop corresponding complications, such as hypopituitarism, urinary collapse, water-electrolyte balance disorders, gastrointestinal bleeding, abnormal body temperature, and in severe cases, coma and even psychiatric symptoms. Generally patients will not have very serious complications, but patients with huge tumors still have a higher chance of having the above symptoms. If postoperative combined with radiation therapy is considered, the purpose of surgery is mainly to decompress and clarify the pathology, then it is not necessary to damage the surrounding important structures for the so-called total removal of tumor during surgery. A large body of literature demonstrates that postoperative supplemental radiation therapy can achieve excellent results: high tumor control, low recurrence rate and, importantly, high quality of patient survival.
Overall, aggressive treatment is a must for patients with pituitary tumors, and it is important for physicians to fully grasp the most advanced minimally invasive concepts, not to be one-sided and not to discard radiation therapy because they only have surgical means, and likewise for physicians who only have radiotherapy means to do radiation therapy beyond indications. Only when surgery and radiotherapy are skillfully combined can we truly achieve minimally invasive treatment with good efficacy.