Etiology
Pituitary tumor is a benign adenoma, a tumor that occurs in the pituitary gland, and is one of the common neuroendocrine tumors, with one case in 100,000 people. The cause is not clear at present.
Clinical manifestations
1.Headache
2, vision, visual field changes (monocular or bilateral eyes do not see clearly, easy to hit the door frame, heavy K gradually develop to blindness or sudden headache blindness).
3, menstrual disorders, menopause, lactation (spontaneous milk flowing from the breast or milk flowing after touching the breast), infertility, change in libido sexual ability (mostly reduced sexual ability), reduction in body hair, skin changes (thinning).
4, acromegaly: progressive enlargement of hands and feet, head, thorax and limbs, hypertrophy of palms, thickening of fingers, spherical distal end, bulging forehead, orbits, cheekbones and under obvious prominence, widening of teeth, thickening of lips, wide and flattened nasal bridge, and enlarged ears.
【Treatment principle】.
1.Surgical treatment: mainly includes craniotomy and transsphenoidal surgical treatment.
2, radiation therapy: general radiotherapy has certain effect on pituitary tumor, but can only control the development of the tumor, sometimes can make the tumor shrink, resulting in improved vision and visual field, but can not fundamentally cure. Head gamma knife treatment can cure pituitary tumor. Gamma knife is not traumatic and is the preferred treatment option for smaller tumors.
Bromocriptine is a semi-synthetic ergotamine alkaloid, which can stimulate the dopamine receptors of pituitary cells to reduce the effect of prolactin in blood. In addition, bromocriptine can also reduce the symptoms of growth hormone adenoma, but the dosage is large and the efficacy is poor.
Health guidance
1.Pre-operative
(1) Talk with patients, encourage them to express their feelings and give psychological guidance.
(2) Advise the patient to rest in bed, keep the room environment quiet and room temperature appropriate, and reduce the stimulation of adverse factors as much as possible, so that the patient can sleep and relax.
(3) Instruct patients to use pain relief techniques: imagery; distraction techniques; relaxation techniques.
(4) Remove obstacles from the environment and keep room objects relatively fixed, and inform the patient of any changes in the placement of objects.
(5) Keep the bed at a low level with rails around the bed.
(6) Support the patient when walking, provide appropriate assistive devices and practice using them.
(7) Provide a high calorie, high protein, high vitamin diet.
(8) Advise the patient to pay attention to personal hygiene, avoid cold, overexertion and excitement, and prevent infection.
(9) Observe pituitary crisis closely and deal with it in time: follow the doctor’s instruction to inject intravenous 50% glucose 40-60ml and sugar saline to rescue hypoglycemia and water loss. For hypothermia, put the patient into 24-35℃ warm water, gradually heat the water temperature to 38-39℃, and when the patient’s body temperature rises above 35℃ then wipe dry to keep warm. Choose a cooling method for hyperthermia according to the specific situation. Morphine barbiturates, chlorpromazine’s and various anesthetics are prohibited or used with caution to prevent inducing coma.
2.Postoperative
(1) Follow the routine of neurosurgical care.
(2) Fast on the day of surgery and record 24h urine volume for 1~3d.
(3) Pay attention to the leakage of fluid in both nostrils.
(4) After 24 h postoperatively, a liquid diet was allowed, and the mouth was gargled with compound boric acid solution 4 times/d for 7 d. The upper gingival incision was disinfected with 0.1% benztropine tincture 4 times/d for 7 d.
(5) The labial compression bandage was removed after 24 h, and the sand strip was removed from the nasal cavity after 48 h. The nasal cavity was disinfected with 0.1% benztropine tincture 4 times/d for 7d. Observe at any time whether there is clear water-like liquid flowing out of the nostrils, while using nasal drops 4 times a day for 14 d. For dry nasal cavity, use sterile paraffin oil drops several times a day.
(6) Avoid violent coughing and forceful nasal blowing after surgery to prevent cerebrospinal fluid nasal leakage.
(7) Absolute bed rest for 1 week after surgery.
(8) Review the pituitary function on the 10th postoperative day.