Pituitary tumors are tumors that occur in the pituitary gland and are common and highly prevalent intracranial benign tumors, mostly seen in women. Although these tumors are benign, the pituitary gland grows in the pterygoid saddle, a narrow space surrounded by bone tissue. Some pituitary tumors are evolved from cells with endocrine function, which can secrete many kinds of hormones. Delayed diagnosis and treatment of pituitary tumors will cause great damage to patients’ health, such as increased hair, irregular menstruation and even infertility in female patients, and decreased sexual function, impotence and infertility in male patients. Therefore, it is crucial to take reasonable and effective treatment for this intracranial tumor in a timely manner. Therefore, early understanding of pituitary tumor symptoms and performance is important for pituitary tumor treatment. Therefore, it is crucial for pituitary tumor patients to be able to detect the symptoms of pituitary tumor in time. So, what are the main hazards of pituitary tumor?
First, the hazards of pituitary tumor.
1. Low male sexual function: low male libido, impotence, no beard, thin voice and sterility; children may have sexual development disorders, such as undeveloped penis, no pubic hair after puberty and no prominent throat nodes.
2, adolescent or married women, menstrual disorders menstrual cycles become longer or amenorrhea, etc., breast overflow, inability to have children; or no lactation after childbirth.
3.Headache: About two-thirds of patients will have headache symptoms in the early stage. The pain site is mainly located behind the orbits, forehead and near the temples bilaterally, and the degree is mild with intermittent attacks. In severe cases of giant pituitary tumors, symptoms of increased intracranial pressure, i.e., headache, dizziness, nausea, vomiting, etc., may also occur.
4. Visual field loss: From the perspective of human anatomy, pituitary gland and optic cross and optic nerve are relatively close to each other. This is especially true when you can’t see pedestrians and vehicles when you are outdoors, which can lead to traffic accidents. There is even the possibility of blindness.
5. Changes in face, limbs and body shape: When there is too much growth hormone, adults will have wide hands and feet, wide head and face, enlarged nose, thickened lips, increased hair, and hoarseness, sleep snoring and sleep apnea syndrome. Children who are taller than normal children, or even elementary school students who are significantly taller than their parents are called gigantism. Acromegaly and gigantism affect aesthetics and can cause a series of life, psychological and social problems for the patient. For example, they may not be able to buy the right clothes and shoes, or they may be nicknamed by their classmates and friends. Insufficient secretion of growth hormone Adults have no obvious performance, some patients may have low fasting blood sugar and slowed fracture repair, while children have growth retardation or stagnation.
6.Other neurological and brain damage: centripetal obesity: Patients will accumulate fat in the chest, abdomen and buttocks, the limbs are relatively thin and small, showing “centripetal obesity”, the face is full-moon shaped, the weight is obviously increased, the subcutaneous blood vessels of the limbs are exposed and purple lines appear. Inadequate secretion of thyroid hormone, fear of cold, hypothermia, poor appetite, abdominal distension, constipation, slow movement, unresponsiveness, swollen face, dry skin, hoarseness, thinning of hair, loss of eyebrows, slow heart rate, and in severe cases, mucus edema, apathy, rigidity, or even coma. Some patients may develop hyperlipidemia and carotenemia, but they are less pronounced than primary hypothyroidism. Those with childhood onset present with growth retardation, bone age lag, and mental retardation. Some patients also show hyperthyroidism, easy agitation, and wasting, and some even undergo thyroidectomy. Insufficient secretion of adrenocorticotropic hormone Loss of appetite, weight loss, general weakness, poor resistance, and susceptibility to infection. Symptoms of hypotension, hypoglycemia and hyponatremia often appear, and severe cases may show critical signs such as nausea, vomiting, hyperthermia and shock.
7. Pituitary stroke: caused by hemorrhage and necrosis in the tumor. The onset of the disease is rapid, with severe headache and rapid visual loss of varying degrees, and in severe cases, double vision within a few hours, often accompanied by extraocular muscle paralysis, which can lead to confusion, disorientation, neck tonicity and even sudden coma.
As each patient’s condition is different, the diagnosis and treatment are different, so once pituitary tumor is found, it must be checked and diagnosed in a regular hospital in time and treated actively to avoid delay.
Diagnostic tests for pituitary tumor
1.Cranial X-ray: Frontal and lateral films show enlarged and deformed butterfly saddle, saddle sunken, with double bottom, saddle dorsum thinned and erected backward, bone often absorbed and destroyed; now rarely used
2.CT scan: the density of pituitary gland is higher than that of brain tissue; due to the influence of bone on imaging, there are generally more missed diagnoses, but it is often necessary to perform CT examination before surgery to understand the bony structure of the operation area. In particular, three-dimensional reconstruction is of great significance for surgery.
3.Magnetic resonance imaging (MRI): the resolving power of soft tissue of the pituitary gland is better than CT, which can make up for the deficiency of CT; it is a necessary item for preoperative preparation and postoperative review.
4.Cerebral angiography: For huge invasive pituitary tumor, it can provide detailed information about the relationship between tumor and large blood vessels.
5. Sex hormone six (serum follicle stimulating hormone, luteinizing hormone, prolactin, estradiol, serum progesterone, serum testosterone), growth hormone, IGF-1 for acromegaly), thyroid function test, serum cortisol.
6. Visual field examination: to understand the compression of the optic nerve by pituitary tumor.
Common treatment methods of pituitary tumor
1.Surgical treatment: Among the treatment methods of pituitary tumor, surgical treatment is the most effective and the main treatment method. Several existing surgical methods are as follows.
(1) Transcranial surgery: Transcranial surgery to remove pituitary tumor has been used in clinical practice for a long time and is now a very mature procedure. At present, the common surgical approaches are transfrontal approach, trans-temporal approach, trans-pterygoid approach and supraorbital foramen approach, and the surgical techniques are very mature. With the development of microscopic and endoscopic techniques, transcranial surgery is now mainly performed for patients who are not suitable for transsphenoidal surgery, such as huge pituitary adenomas, especially invasive tumors; patients who need combined access and staged surgery. However, it is very traumatic, with heavy reaction and slow recovery.
(2) Transnasal butterfly surgery: It mainly includes microscopic transnasal butterfly and endoscopic transnasal butterfly surgery, both of which are well established and are the most common surgical approaches for pituitary adenomas. In the past, patients with pituitary adenomas of the mesenteric or anterior saddle sinus type were contraindicated for the transsphenoidal approach due to the difficulty of intraoperative localization and exposure of the saddle base, or required additional equipment to intraoperatively localize the saddle base. However, with continued advances in surgical techniques and equipment, and with illumination provided by a microscope, the anterior wall of the pterygoid sinus is reached through a nasal spreader, the posterior segment of the nasal septum is propped open and squeezed to the opposite side, and the pterygoid sinus is opened to expose the tumor. This procedure allows the operator to operate with both hands and conforms to the conventional surgical habits, but it may destroy the original structure of the pterygoid bone and shift the physiological midline localization markers, and the illumination is limited, with more blind areas in the saddle and serious light attenuation of deep illumination, so it is easy to cause tumor residual or cerebrospinal fluid leakage from the broken saddle septum during surgery of large or huge adenoma. Nowadays, the multimodal image reconstruction navigation technology can display the three-dimensional anatomical images of the superficial and deep structures of the butterfly sinus, which can simulate the transnasal butterfly approach procedure. With the microscope, transsphenoidal giant pituitary tumor resection is less traumatic, faster recovery, and less impact on pituitary endocrine has been recognized by the majority of pituitary tumor specialists.
(3) Neuroendoscopy: Neuroendoscopic transsphenoidal pituitary adenoma resection is a minimally invasive pituitary adenoma resection technique that has been carried out and rapidly promoted at home and abroad in the past 20 years, with obvious advantages over previous microscopic surgery.
(i) The damage to the mucosa at the base of the nasal cavity and the upper middle part of the nasal septum is reduced, and postoperative septal perforation rarely occurs.
(ii) It does not cause bony septal fractures and does not affect the postoperative nasal shape.
â‘¢Provides better illumination and can magnify the image for better display of the anatomical structures in the pterygoid sinus and the intra- and supra-saddle, reducing the possible postoperative complications.
â‘£Patients have a mild postoperative reaction and quick recovery. However, endoscopy also has its disadvantages, endoscopy is to display the three-dimensional structure through the screen in a flat image, lacking a sense of three-dimensional hierarchy, requiring a high level of operator proficiency, and the need to find a reference in the nasal cavity as a ruler; and the operating space is more narrow compared to microscopic surgery, and special training is required for surgical operation.
2.Radiation therapy: i.e. radiotherapy, gamma knife therapy is commonly used for pituitary tumors. Since pituitary tumors are adenomas, they are less sensitive to radiotherapy, and 70%-80% of patients have reduced pituitary function after radiotherapy, which reduces the quality of life of patients. Therefore, radiotherapy is only suitable for patients who cannot tolerate surgery, are not sensitive to drugs, or have co-morbidities that cannot be treated with surgery or drugs.
3.Medication: Among all types of pituitary tumors, only pituitary tumors with abnormal endocrine examination can be treated with western medicine with certain effect, but it cannot cure pituitary tumors, and it may take medicine for a lifetime. Therefore, western medicine treatment is only suitable for pituitary tumors with increased prolactin, GH adenoma, ACTH adenoma, etc. Also, the medication needs to be stopped after pregnancy to avoid affecting the fetus. Since western medicine does not make the tumor disappear, the symptoms will recur after stopping such medicine and the tumor will continue to grow. After long-term medication, the pituitary tumor will harden, which will bring difficulties to the future surgery.
4.Chinese medicine treatment: Chinese medicine can’t cure pituitary tumor, at present, it is mainly used as a kind of adjuvant treatment, which can relieve some symptoms of patients. Especially after surgery and radiation therapy to help patients recover their strength as soon as possible.