The pituitary gland is located in the pituitary fossa of the disc saddle at the base of the skull, and is connected to the hypothalamus by the pituitary stalk, its size is 1.2cm long, 0.8cm wide and 0.6cm high, weighing about 0.5g, slightly larger in women than in men, and more obvious during pregnancy.
The anterior pituitary gland secretes a variety of hormones, such as adrenocorticotropic hormone (ACTH), growth hormone (GH), prolactin (PRL), luteinizing hormone (LH), follicle stimulating hormone (FSH) and thyroid stimulating hormone (TSH). The posterior pituitary gland mainly stores antidiuretic hormone (ADH) and oxytocin, which are secreted by the hypothalamus.
Pituitary tumors are benign adenomas and are quite common, with one case in 100,000 people, and there is an increasing trend in recent years, especially in women of childbearing age. The Beijing Institute of Neurosurgery reports that pituitary tumors account for 12.2% of intracranial tumors.
Clinical manifestations
Pituitary gland is an important endocrine organ, which contains several kinds of endocrine cells and secretes many kinds of endocrine hormones.
If a certain endocrine cell grows adenoma, special clinical manifestations may occur.
1. Endocrine manifestations of different kinds of pituitary adenomas
(1) Growth hormone cell adenoma: The early tumor is only a few millimeters in size and mainly shows excessive secretion of growth hormone. It can grow too fast and even become a giant in immature patients. In adulthood, the tumor may show signs of hypertrophy of the extremities. For example, the face changes, the forehead becomes bigger, the jaw protrudes, the nose is bigger and the lips thicker, the fingers become thicker, the shoes and hats feel tighter, the larger models are changed several times, and even have to be specially made, some patients also have an increase in the amount of food, rough hair and skin, pigmentation, numbness of the fingers, etc.. In severe cases, they feel general weakness, headache and arthralgia, hypogonadism, amenorrhea and infertility, and even complications of diabetes.
(2) Prolactin cell adenoma: The main manifestations are amenorrhea, overflow of milk, infertility, axillary hair loss, pale and delicate skin, increased subcutaneous fat, as well as weakness, fatigue, drowsiness, headache, and hypogonadism. In men, the symptoms include loss of libido, impotence, breast enlargement, beard thinning, atrophy of the reproductive organs, reduction of sperm count, and infertility, etc. There are not many male and female patients.
(3) Adrenocorticotropic hormone cell adenoma: Clinical manifestations are centripetal obesity, full-moon face, buffalo back, polycythemia, purple lines on the skin of the abdomen and thighs, and increased fine hair. In severe cases, amenorrhea, loss of libido, general weakness, and even bedridden. Some patients also have hypertension, diabetes, etc.
(4) Thyroid-stimulating hormone cell tumor: Rarely, hyperthyroidism is caused by excessive secretion of thyroid-stimulating hormone from the pituitary gland, and the symptoms disappear after removal of the pituitary tumor. The symptoms of hyperthyroidism will disappear after removal of the pituitary tumor. There are also cases of focal hyperplasia of the pituitary gland caused by hypothyroidism feedback, which gradually develops into pituitary adenoma and can cause symptoms of enlargement of the pterygoid saddle and compression of the nearby tissues.
(5) Follicle-stimulating hormone cell adenoma: It is very rare, and only some individuals report clinical hypogonadism, amenorrhea, infertility, and reduced sperm count.
(6) Melanin-stimulating hormone cell adenoma: Very rare, only a few patients reported black skin pigmentation without cortisol increase.
(7) Endocrine inactive adenoma: In the early stage, the patient has no special feeling that the tumor is growing and can compress the pituitary gland causing clinical manifestations of pituitary insufficiency.
(8) Malignant pituitary tumor: short history and rapid progress of disease, not only the tumor grows to compress the pituitary tissue, but also invades to the surrounding area, causing destruction of the bone of the saddle base or infiltrating into the cavernous sinus, resulting in actinic nerve paralysis or abducens nerve paralysis. Sometimes the tumor penetrates the saddle base and grows into the pterygoid sinus, and the neurological symptoms are not obvious for a short period of time.
2.Visual field disorder: Early pituitary adenoma often has no visual field disorder. If the tumor grows up and extends upward, compressing the visual cross, visual field defect will appear, the outer upper quadrant will be affected first, and the red visual field will be shown first. Later, when the lesion increases and the pressure is heavier, the white visual field is also affected, and gradually the defect may expand to bilateral temporal hemianopia.
If left untreated, the visual field defect can be further enlarged and the visual acuity can be diminished to total blindness. Because pituitary tumors are mostly benign, the initial lesions can last for a considerable period of time, but when the disease is serious, the visual field impairment can suddenly increase, and if the tumor is on one side, it can lead to monocular blindness or blindness.
3. Other neurological symptoms and signs: If the pituitary tumor grows upward and presses the pituitary stalk or hypothalamus, it may cause polyuria; if the tumor grows laterally and invades the wall of cavernous sinus, it may cause nerve palsy of the motoneurotic nerve or abducens nerve; if the tumor grows upward through the saddle septum to the ventral part of frontal lobe, it may cause psychiatric symptoms; if the tumor grows upward and blocks the anterior part of the third ventricle and interventricular foramen, it may cause headache and vomiting, etc. If the tumor grows posteriorly and obstructs the anterior part of the third ventricle and interventricular foramen, headache, vomiting and other symptoms of increased intracranial pressure will appear.
Clinical manifestations of pituitary tumor Pituitary tumor mostly occurs in young adults aged 20 to 50 years old, and is rare in the elderly, especially in children, with roughly equal incidence in men and women.
Its clinical manifestations may appear as 1 or more of the following.
1.Headache.
2. Visual field changes (unclear vision in one or both eyes, easy to hit the door frame, progressive development of blindness or sudden headache blindness in severe cases).
3.Menstrual disorders, menopause, lactation (spontaneous milk flow from the breast or milk flow after touching the breast), inability to conceive, change in libido sexual ability (mostly reduced sexual ability), decrease in body hair, skin changes (thinning).
4, acromegaly: progressive enlargement of the hands and feet, head, thorax and limbs, hypertrophy of the palms of the hands and feet, thickening of the fingers, the distal end is spherical, forehead bulge, orbits, cheekbones, that is, the jaw is obviously protruding, widening of the teeth, thickening of the mouth and lips, wide and flattened nasal bridge, large ears, hats, shoes and socks, gloves often.
Auxiliary examination
How can pituitary tumors be detected early?
It should be taken seriously after the appearance of related symptoms, such as a CT examination, and then after a more detailed MRI examination, it can be clarified. Generally speaking, if endocrine changes are not effective after treatment, or if headache, visual impairment, or endocrine any of them appear, it should be considered, and if they appear at the same time, it should be promptly checked.
Pituitary tumors are usually found in women aged 20-40 years old, because women have more hormonal changes and fluctuations during their lifetime.
1.Endocrinological examination: The application of endocrine radioimmuno-ultra-microscopic method to directly measure growth hormone, prolactin, adrenocorticotropic hormone, thyroid-stimulating hormone, melanin-stimulating hormone, follicle-stimulating hormone and luteinizing hormone of pituitary gland is very helpful for the early diagnosis of pituitary adenoma.
2.Radiological examination
(1) Pterygoid saddle image: It is one of the basic examinations. When the pituitary tumor is small, there may be no change in the saddle, but as the tumor grows, the saddle may be enlarged, the bone is destroyed, and the saddle back is eroded.
(2) CT scan: After enhancement with intravenous contrast, it can show pituitary adenoma of 5mm in size. Smaller tumors are still difficult to show.
【Treatment measures
1.Surgical treatment: mainly includes open surgery and transsphenoidal sinus surgery. The safety of transnasal endoscopic surgery is higher than that of craniotomy, and the neurosurgery department of Tong Ren Hospital has carried out many cases and has rich experience. Surgery is the best treatment effect and the most thorough treatment method.
2, radiation therapy: ordinary radiotherapy has a certain effect on pituitary adenoma, can only control the development of the tumor, and sometimes make the tumor shrink, resulting in improved visual field, but can not fundamentally cure; only the head gamma knife treatment is the root of pituitary tumor. Gamma knife treatment of pituitary adenoma, the efficacy is certain, less pain, light reaction, tumor in the treatment of six months will gradually shrink, abnormal hormonal changes will gradually return to normal. Gamma knife is not traumatic and is the preferred treatment option for smaller tumors.
3.Medication: Bromocriptine is a semi-synthetic ergotamine alkaloid, which can stimulate the dopamine receptors of pituitary cells to reduce the effect of prolactin in blood. Bromocriptine can reduce the size of prolactin adenoma, restore menstruation and ovulation and conception, and suppress pathological overflow of breast milk, but bromocriptine cannot cure prolactin adenoma at all. In addition, bromocriptine can also reduce the symptoms of growth hormone cell adenoma, but the dosage of the drug is large and the efficacy is poor.
After treatment]
Will the tumor recur after surgery?
Objectively speaking, any tumor may recur, only benign tumors have a relatively long recurrence time, such as after ten or twenty years. If the surgical removal is complete and there is no residual root, it is difficult to recur. The recurrence of pituitary tumor is usually possible after 10-20 years or even longer with complete removal. For middle-aged people, one surgery may be enough, while young people can have a second surgery after one surgery.
Pituitary tumor can break through the saddle and grow downward in the butterfly saddle, and invade important blood vessels and nerves in both sides of the skull, but the most common way of growth is to develop upward in the saddle and compress the optic cross and optic nerve, which causes vision loss and visual field impairment.
Patients often complain of vision loss, not being able to see both sides, and always hitting the door. If visual field impairment occurs, surgery is needed as soon as possible to release the compression on the optic nerve and save vision. If it is accompanied by growth in other directions, it is called invasive pituitary adenoma, which is significantly more difficult to treat and difficult to remove at once.