As the saying goes, “Treat the head when it hurts and treat the foot when it hurts.” The first thing people consider is to go to the department that corresponds to these parts of the body, but in fact, the symptoms of some diseases are often manifested in other seemingly unrelated parts of the body, such as the brain tumor patients admitted to our brain surgery department. Vision loss, sexual dysfunction, menstrual irregularities …… When such symptoms occur, where would you go for consultation? It must be ophthalmology and gynecology. But when the treatment does not work, have you considered that such symptoms also mean you may have a brain tumor? Pituitary adenoma is one of the most common benign tumors in the skull, with a general population incidence of 1 per 100,000. If early diagnosis and early treatment can be obtained, the treatment outcome will be relatively good. However, due to the inappropriate choice of early consultation department, a considerable number of patients are delayed in diagnosis. The author combines some cases encountered in the clinic to give a hint on the early manifestation symptoms of pituitary adenoma, hoping to draw the attention of related patients. Case A: Patient Zheng, male, 44 years old, felt blurred vision in both eyes for two years, but he did not pay attention to it. He had been treated for ophthalmologic diseases, but his vision did not improve. Recently, the vision loss in the left eye became more obvious, and the ophthalmologist told him that the optic nerve in the left eye had atrophied, and only then he found a tumor in the intracranial saddle area with a diameter of 3cm, which obviously compressed the optic nerve. Analysis: The loss of vision is caused by the growth of pituitary adenoma tumor to the saddle to compress the optic nerve. Some patients can only show vision loss, which usually occurs when the tumor grows larger and presses the optic nerve. If the optic nerve is compressed for a long time and the vision is also obviously decreased, the tumor has grown larger by then. Although surgery can decompress the optic nerve to improve the vision, it is more difficult to cure the tumor. Therefore, the early stage of vision loss should be taken seriously. After the ophthalmic disease is excluded, the possibility of intracranial saddle area tumor should be thought of. In addition, there is another manifestation that should be paid attention to, that is, the visual field on both sides of the patient has become narrower, and it is easy to hit the objects on both sides when walking, and some patients can be on one side of the eye. Case B: Patient Wang, male, 40 years old, the patient said that his sexual function is not working for more than 10 years, the early stage is the decline of sexual desire, later is the erection is not working, always feel weak, beard thinning. Because it is difficult to mention to people, the first few years have not been consulted. In the last two years, after the serious disorder of sexual life, only after seeking medical attention everywhere, a variety of Chinese herbal medicine and Western medicine, but all do not work. Later, a neighbor had a pituitary adenoma and the symptoms were very similar.
The CT suggested that it was a tumor in the saddle area and pituitary adenoma was more likely. Analysis: There are two mechanisms by which pituitary adenomas can cause sexual dysfunction: first, in patients with prolactin adenoma (a type of pituitary adenoma), high prolactin secretion inhibits the function of the hypothalamic-pituitary-gonadal axis, causing a decrease in sexual function; second, in other pituitary adenomas, the tumor is large and compresses the normal pituitary gland causing hypopituitarism, resulting in a decrease in sexual function. Since patients themselves are reluctant to take the initiative to explain to their physicians, pituitary adenomas cause far more sexual dysfunction than we see in clinical practice. Decreased sexual function can manifest itself in various degrees, with male patients exhibiting decreased sexual desire, erectile failure, and in severe cases, impotence (2% of impotent patients are due to prolactin adenoma). In women, the decrease in sexual desire and vaginal secretion can be severe enough to cause infertility. Although the decline in sexual function is not always caused by pituitary adenoma, the earliest symptom of some patients with pituitary adenoma is the decline in sexual function, which patients should take the initiative to explain to their physicians when they seek medical attention, which can greatly improve the accuracy of diagnosis. Case C: Patient Lin, female, 35 years old. Her menstruation has been irregular for the past 5 years, starting with scanty and irregular periods, sometimes only once every 2 to 3 months, and stopping for the last 1 year, accompanied by lactation in both breasts. The patient did not seek medical attention during the first two years of irregular menstruation because she grew up in a rural area and had poor economic conditions. Only recently was a pituitary adenoma detected by cranial CT, as recommended by our obstetrician and gynecologist. Analysis: One can hardly imagine associating brain problems with bad menstruation. Pituitary adenomas also cause changes in the function of the gonadal axis due to high prolactin secretion or tumor compression of the normal pituitary gland, which leads to changes in the menstrual cycle and volume. Approximately 5% of primary amenorrhea and 25% of secondary amenorrhea is caused by a prolactin adenoma (a type of pituitary adenoma). If amenorrhea is accompanied by lactation, the probability of having a prolactin adenoma increases to 70-80%. A woman with a change in menstrual symptoms should think about the possibility of a pituitary adenoma after gynecological diseases have been excluded. Although the duration of symptoms is not proportional to the size of the tumor, the prognosis of patients is relatively good if diagnosed and treated early. Of course, pituitary adenomas are not limited to the above-mentioned manifestations. 2/3 of patients may have early headaches of varying degrees, mainly located in the orbits, forehead and bilateral temples. For example, growth hormone adenoma may present as gigantism or hypertrophy of the extremities of the hands and feet; adrenocorticotropic hormone adenoma may present as characteristic obesity, etc. It is easier to detect the tumor early. Several of the above symptoms can appear together, such as headache, vision loss and menstrual changes, which are highly suggestive of pituitary tumor. If only one symptom appears, it is easy to miss the diagnosis and misdiagnosis, which will affect the treatment effect. The early detection of pituitary adenoma, which is less than 1 cm and is a microadenoma, has a cure rate of about 90% for experienced neurosurgeons, while the cure rates for large adenoma or giant adenoma are 30%-50% and 0%-5% respectively, which fully illustrates the importance of early detection of pituitary adenoma. The patient’s own medical knowledge and the doctor’s level of diagnosis and treatment are equally important. Combining the above three cases, we hope to help in the early diagnosis of pituitary adenoma.