Pituitary adenomas are benign tumors that occur in the anterior pituitary gland and are one of the most common intracranial tumors, accounting for about 10-15% of intracranial tumors. the average autopsy detection rate of pituitary adenomas is about 20. with the development of medical examination techniques, the detection rate of pituitary adenomas has increased significantly, with some reports reaching 20. the detection rate of pituitary adenomas by random magnetic resonance imaging (MRI) can be 10 or more. It is the third most common disease after diabetes mellitus and thyroid disease.
Pituitary adenomas can occur at any age, with those aged 30 to 50 years being the most common, and the incidence of pituitary adenomas in children is low, accounting for only 2 to 6 percent of pituitary adenomas. Functional adenomas include growth hormone adenomas and gonadotropin adenomas, while ACTH adenomas are rare.
In the elderly, prolactin adenomas are usually aggressive macroadenomas, probably due to the lack of symptoms of hyperprolactinemia in this age group. There is no significant gender difference in the incidence of each type of pituitary adenoma, except for the prolactin type, which is significantly more common in women than in men.
Patients with pituitary adenomas have clinical manifestations that vary in severity at different times after the onset of disease. Hypogonadism occurs in 3/4 of adults, and amenorrhea and lactation can occur in young women. If it is growth hormone type, it can manifest as gigantism or acromegaly; if it is ACTH type, it can manifest as centripetal obesity, hypertension, hyperglycemia, etc.
Due to hypopituitarism, some patients will show hypopituitarism, children will show short stature and underdeveloped sex organs, and some children with pituitary adenoma will show obesity. If the tumor affects the visual pathway, different degrees of visual acuity loss and different types of visual field defects will occur; if the tumor compresses the saddle septum, it may cause bilateral temporal, frontal and posterior nasal root distension; if the tumor breaks through the saddle septum and invades the frontal lobe, temporal lobe or even protrudes into the third ventricle to cause obstructive hydrocephalus, it may cause obvious headache, nausea, vomiting and even impaired consciousness and other high cranial pressure symptoms.
About 5-10 patients may suffer from tumor stroke, which is characterized by sudden headache, vomiting, rapid vision loss, and some patients may suffer from acute pituitary failure such as mental depression, unstable vital signs or even coma. Some patients with tumor invasion of cavernous sinus can show oculomotor nerve damage such as eyelid ptosis and eye movement disorder.
Treatment of pituitary adenoma includes surgery, radiation therapy and medication. Surgery is the main treatment for most pituitary adenomas, and 90% of them can be done through a nasopalatine approach. Radiation therapy is used as a complementary tool to surgery. Due to the availability of new drugs, pharmacotherapy has broken new ground to traditional treatment methods and has replaced surgery as the main treatment method in some pituitary adenomas.
In recent years, with the development of endocrine microhormone measurement and immunohistochemistry, the improvement of neuroimaging and microsurgery techniques, the application of neuroendoscopy and neuronavigation technology, along with the in-depth concept of minimally invasive and the new understanding of pituitary adenoma treatment, the individualization of treatment, the rational application of comprehensive treatment, the importance of long-term follow-up and follow-up treatment after treatment are emphasized. During the diagnosis and treatment process, scientific decision making, comprehensive evaluation, individualized and standardized treatment are combined to prevent “over-treatment”.