Pituitary adenomas have a high clinical incidence. Pituitary adenoma is a benign adenoma and is the most common tumor in the saddle area, with an increasing trend in recent years, especially in women of childbearing age. The Beijing Institute of Neurosurgery reports that pituitary adenomas account for 12.2% of intracranial tumors.
Clinical manifestations: it is related to the patient’s gender, age, tumor size and expansion direction and the type of hormone secretion, including the following 4 groups of symptoms.
1.Signs and symptoms caused by excessive hormone secretion from pituitary tumors, the common ones are acromegaly, Cushing’s disease and prolactinoma.
2, the pituitary gland itself is under pressure syndrome, mainly the pituitary gland prohormone secretion is reduced, generally affects the growth hormone GH first, followed by luteinizing hormone, follicle stimulating hormone, and finally adrenocorticotropic hormone, thyrotropin, a few can be accompanied by uremia.
Peripituitary tissue compression syndrome, including headache, vision loss, visual field defects, hypothalamic syndrome, cavernous sinus syndrome and cerebrospinal fluid nasal leakage.
4, pituitary stroke, refers to pituitary adenoma and/or infarction, necrosis or hemorrhage of the pituitary gland itself, clinical symptoms of compression and meningeal irritation may appear rapidly, clinical manifestations of hyperpituitary function may disappear or be reduced, or even hypopituitary hypofunction may appear.
Auxiliary examinations.
1.Endocrinological examination
Endocrine radioimmuno-ultra-microscopic method is used to directly measure growth hormone, prolactin, adrenocorticotropic hormone, thyroid-stimulating hormone, melanin-stimulating hormone, follicle-stimulating hormone and luteinizing hormone in pituitary gland.
2.Radiological examination
(1) The pterygoid saddle image is one of the basic examinations. When pituitary adenoma is small, there can be no change in the saddle, but as the tumor grows, it can lead to saddle enlargement, bone destruction and saddle back invasion.
(2) CT and MRI scans can show pituitary adenoma of 5mm size after enhancement with intravenous contrast agent. Smaller tumors are still difficult to show.
Treatment.
Pituitary ACTH adenoma – surgery preferred
Pituitary GH adenoma – surgery preferred
Non-functioning pituitary microadenoma: tumor is partial to one side with clear borders to pituitary gland, surgery is preferred;
If pituitary gland is not concentrated, enlargement of resection is difficult, clinical observation is recommended.
Pituitary non-functional macroadenoma: surgery is preferred
Pituitary PRL microadenoma: bromocriptine treatment is preferred
Surgery may also be preferred if the tumor is located on one side and has a clear border with the pituitary gland.
Pituitary PRL macroadenoma: Significantly elevated PRL, drug therapy preferred
Insignificant elevation of PRL, surgery is preferred, followed by bromocriptine treatment or radiotherapy
Invasive pituitary PRL adenoma: significantly elevated PRL, drug therapy preferred
Insignificant elevation of PRL, surgery preferred, postoperative radiation therapy
Patients with pituitary adenomas with fertility requirements: choose radiation therapy, especially gamma knife therapy, with caution
At present, the surgical treatment of pituitary adenoma is more than 90% transsphenoidal pituitary tumor resection (through unilateral nasal cavity – pterygoid sinus – saddle base – tumor), with short operation time, few complications and fast recovery of patients.