I. Clinical manifestations of pituitary adenoma
Pituitary adenomas account for 10% of intracranial tumors and can be divided into two categories, functional and non-functional, according to the functional classification. Functional pituitary adenomas are divided into growth hormone adenoma (GH), prolactin adenoma (PRL), adrenocorticotropic hormone adenoma (ACTH), thyrotropin adenoma (TSH), and gonadotropin adenoma (FSH/LH).
1. Headache: About 2/3 of patients with non-functional adenoma complain of headache, mostly in the bilateral temporal and frontal areas. GH adenoma causes more pronounced and persistent headache, but the location is not uniform.
2.Visual impairment: When the tumor grows up to the saddle and presses the optic nerve intersection, it can produce visual impairment. Patients show visual impairment, visual field loss and optic nerve papillary atrophy, visual impairment is usually seen in non-functional adenoma.
3. Endocrine disorders.
1) PRL adenoma: Mostly seen in females, the age of onset is 20-40 years old. The main clinical manifestations are menstrual disorders, amenorrhea, lactation, infertility, and some are accompanied by hypogonadism and obesity. In male patients, impotence, hypogonadism, infertility, male breast development, etc. Serological examination suggests: increased blood PRL.
2) GH adenoma: If it occurs in children before epiphyseal closure, it is called “gigantism”, and in adults, it is called “acromegaly”. The main manifestations are: abnormal height and rapid growth in children. In adults, the symptoms include enlarged forehead, protruding jaw, enlarged nose, thickened pronunciation, enlarged hands and feet, rough skin, and hyperpigmentation. Male patients show hypersexuality in the early stage and hypoactive sexual desire or disappearance in the late stage. Female patients may have menstrual disorders, amenorrhea or no sexual desire. About 1/3 of patients may have diabetes mellitus, and endocrine serum blood tests suggest elevated blood GH.
3) ACTH adenoma: Mostly seen in young women, mainly manifested as centripetal obesity, full moon face, buffalo back, purple lines on lower abdomen and inner side of both thighs, increased hair and skin acne. Women may have amenorrhea. Some patients are combined with hypertension and diabetes mellitus, and endocrine blood tests suggest increased blood ACTH.
4) FSH or LH adenoma: slow onset, lack of specific symptoms, mostly seen in men, early manifestation is hypogonadism, late stage mostly has headache, visual acuity and visual field disorder, easily misdiagnosed as non-functional pituitary adenoma. Endocrine blood tests are mainly for elevated FSH, LH or both.
5) TSH adenoma: It is relatively rare and mainly presents with symptoms of “hyperthyroidism”: enlarged thyroid gland, tremor, murmur, easily agitated, trembling hands, excessive sweating, tachycardia, emaciation, etc. Endocrinological examination of TSH, T3 and T4 are all elevated.
6) Mixed pituitary adenoma: It may show clinical symptoms arising from the increase of several hormones.
7) Non-functional pituitary adenoma: It is more common in males than females over 30 years old, and the clinical manifestations are mainly hypopituitarism. The clinical manifestations are mainly hypopituitarism. Men show hypogonadism, impotence, scarcity of beard, shrinking of external genitalia and thinning of skin; women show menstrual disorders, amenorrhea, atrophy of uterus and breast, loss of libido, scarcity of pubic and axillary hair and obesity. Patients may also have cold fear, depression, poor resistance to disease, and susceptibility to infection. Endocrinological examination may have one or more low hormone levels.
Second, the pituitary adenoma gamma knife treatment
1, indications.
1) pituitary microadenoma.
2) pituitary macroadenoma (those without significant impairment of vision and visual field).
3)postoperative residual pituitary tumor or postoperative recurrence of pituitary tumor.
4)Patients who cannot tolerate surgery because of their advanced age and poor physical condition.
2.Evaluation of treatment effect.
Gamma knife treatment effect of pituitary adenoma is similar to the effect of traditional surgical treatment methods. The patient’s clinical symptoms improve up to about 90-95%, the tumor disappears or shrinks up to 85-90%, functional pituitary adenoma hormone levels return to normal or drop 70-75%.