Pituitary tumors develop from the anterior pituitary gland and are mostly benign, accounting for about 10-12% of intracranial tumors. Pituitary tumors that are less than 1 cm in diameter and confined to the saddle are called microadenomas.
With the increasing level of pituitary tumor detection, the incidence of pituitary tumors has a tendency to increase year by year. At present, there is a lack of epidemiological survey data of pituitary tumors in China. According to the American epidemiological survey, the incidence of pituitary adenoma is 7.5-15/100,000. The incidence of pituitary adenoma during autopsy of normal deceased patients varies, ranging from 9% to 65%.
Based on 225 surgically resected specimens, anterior pituitary tumors were classified as follows: prolactin cell adenomas in 32%, with clinical symptoms such as overflow and hypogonadism; growth hormone cell adenomas in 21%, with acromegaly or gigantism; adrenocorticotropic adenomas in 13%, with Cushing’s syndrome or no obvious clinical signs; undifferentiated cell adenomas in 23%, with hypopituitarism; and asymptomatic adenomas. Asymptomatic eosinophilic adenomas accounted for 3.5%. Posterior pituitary tumors are rare and have a high probability of malignant lesions.
The clinical treatment goal of pituitary tumor is to maximize tumor growth control and normalize hormone levels in the shortest possible time to eliminate symptoms and signs; at the same time, to minimize treatment complications and to protect the normal endocrine function of the pituitary gland as much as possible. The current treatment methods in Western medicine are mainly surgery, radiotherapy and drug therapy. The preferred treatment for large pituitary tumors is surgery. Surgery can quickly relieve tumor compression and hormone hypersecretion, but it cannot completely remove pituitary tumors with paracentral and cavernous sinus invasion. Radiation therapy has better efficacy for postoperative residual and recurrence; however, it is easy to lead to hypopituitarism and concurrent post-radiotherapy optic nerve injury. While PRL tumors are first considered for pharmacological treatment, the preferred drug is dopamine agonist, among which bromocriptine is preferred to restore ovulation; taking bromocriptine requires constant dose adjustment, and the larger the tumor, the higher the dose taken and the more obvious the accompanying adverse effects. In patients with dopamine resistance, bromocriptine is not effective. In the outpatient clinic, it was observed that some patients with normal serum prolactin levels after taking bromocriptine had difficulty in restoring normal menstrual cycle and volume due to long-term amenorrhea. Cabergoline is effective in improving overflow symptoms and sex hormone levels, but serum PRL levels fluctuate, and for large tumors and residual tumors cabergoline has the risk of increasing the recurrence rate.
Chinese medicine’s understanding of the etiology and pathogenesis of pituitary tumors There are no exhaustive records of pituitary tumors in Chinese medical texts. The clinical symptoms of pituitary tumors are diverse, with different pituitary adenomas and tumor sizes having an impact. On imaging, pituitary tumors are manifested as hyperplasia of pituitary tissues, which can be identified as “Y-accumulation”. According to the different symptoms of different types of pituitary tumors, they can be classified as “headache”, “amenorrhea”, “infertility” and so on. Most clinical cases are characterized by irregular living habits: irregular starting and stopping, uncontrolled drinking and eating, fatty, sweet and greasy, lack of exercise, easy injury to the spleen and stomach, easy brewing of phlegm, stagnation of phlegm and gas, poor blood circulation, internal stagnation of blood stasis, phlegm and stagnation of blood, blockage of veins and channels, gradually becoming Y accumulation.
Typical case: Initial diagnosis (June 12, 2009): Zhao, female, 23 years old, with irregular menstruation for more than five years. 2006, the patient’s menstrual cycle was disordered, sometimes postponed, sometimes stopped, with low menstrual volume, accompanied by blood clots; menstrual pain in the small abdomen; long term treatment at the gynecology and endocrinology outpatient clinics of Chinese and Western medicine hospitals, had taken progesterone, after taking the drug, menstruation was still okay, low volume, after stopping the drug, menopause. 2009, the Sixth People’s After taking 2 capsules of bromocriptine, her menstrual cycle was normal, and she had headache symptoms. She was referred by a friend to see Prof. Zhang Qiujuan. The patient wanted to stop taking bromocriptine and use Chinese herbal medicine instead. At the time of consultation, the patient was taking 1 capsule of bromocriptine, serum prolactin (PRL): 131.48 ng/ml (normal range: 3.34-26.72 ng/ml); the patient had headache and pain, stomach and appetite, and liked to eat sweet and thick food, cold and sweet food, sometimes constipated and sometimes loose stools, usually sleeping late; the tongue was light red, with teeth marks on the side, white and greasy moss, and small string pulse.
The diagnosis of TCM is Y accumulation and menstrual disorder; the evidence belongs to internal obstruction of phlegm and stasis; analysis: phlegm and stasis wrestle with knots, obstructing the brain ligaments, pain if not pass, blood vessels are not harmonized, menstruation is delayed and does not come. Prescription: Self-formulated Brain Disease I formula to dissolve phlegm and disperse nodules, invigorate blood circulation and promote menstruation, 1 dose per day, taken twice with water decoction. Take 1/2 capsule of bromocriptine. She was instructed to change her lifestyle, eat a balanced diet and keep her bowels open.
Second consultation (June 26, 2009): The patient has been menstruating since June 23, with low menstrual flow, menstruation with blood clots and abdominal distension, and menstruation dripping on the third day of menstruation. No obvious headache symptoms with half capsule of bromocriptine. The tongue is light red, with tooth marks on the side, thin white fur, thin pulse; consider phlegm and dampness trapping the spleen, spleen loss of health, lack of source of Qi and blood biochemistry, visible deficiency of Qi and blood.
Follow-up consultation (December 9, 2009): The patient took herbal medicine continuously for six months. At the time of follow-up consultation, the patient had a menstrual cycle of 28 days, moderate menstrual volume, less blood clots, no obvious abdominal pain. 24.53ng/ml PRL, stop taking bromocriptine.
Follow-up consultation (June 23, 2010): The patient continued to take herbal medicine. At the follow-up consultation, the patient’s menstrual cycle was normal, about 28 days, with moderate menstrual flow and no obvious discomfort. PRL 12.96ng/ml. Follow-up consultation (January 31, 2011): The patient’s Yueyang Hospital cranial MR suggested no abnormality. The patient has had normal menstrual cycle for the past two years, about 28 days, menstrual volume can be seen, few blood clots, no symptoms such as dysmenorrhea.
At present, most of them are completely cured within two years after taking herbal medicine (normal menstrual volume, normal serum PRL, MR suggesting normal pituitary gland), some patients suspend the medicine due to pregnancy, the rest of them have different degrees of improvement, and the recovery of menstruation and serum PRL is more obvious.