1. Symptoms caused by tumor occupancy: (1) Vision loss, visual field hemianopia: caused by upward pressure of tumor on visual cross. (2) Headache: caused by the tumor pulling the saddle diaphragm when growing from the saddle to the upper saddle, affecting the arterial ring of skull base or the ophthalmic branch of trigeminal nerve. (3) Endocrine dysfunction: It often varies according to the nature of tumor, often with sexual dysfunction, growth disorder, etc. Late stage tumor grows posteriorly and presses on pituitary stalk or hypothalamus, which may cause urolithiasis. (4) Intracranial hypertension symptoms: If the tumor grows up to the saddle, blocking the anterior part of the third ventricle and interventricular foramen, leading to hydrocephalus, headache, vomiting and other intracranial hypertension symptoms may occur.
Clinical manifestations caused by abnormal secretion function (1) PRL adenoma: It is common in women and manifests as amenorrhea, breast milk overflow and non-expectant syndrome. Men show impotence, sexual hypogonadism, breast enlargement, beard thinning, etc. Plasma prolactin value >200vgr~ has diagnostic value.
(2) GH adenoma: Increased plasma GH causes systemic metabolic disorders, adults mostly show acromegaly, resulting in excessive growth of bone, cartilage tissue and internal organs, making the head square, high cheekbones, enlarged nose, thick lips, thick hands and feet, often accompanied by hypertension and diabetes; before puberty, gigantism, abnormally tall, easily fatigued, poor immunity and easy to catch colds, etc. Plasma GH value ≥10L1 water has diagnostic value. In the glucose suppression test, GH level cannot be suppressed to less than 1mg/mL within 60 minutes. (3) ACTH adenoma: Mostly seen in young and strong females, the patient shows centripetal obesity, buffalo back, full moon face, subcutaneous purple lines, and often accompanied by hypertension.
(4) TSH adenoma: TSH-secreting pituitary tumors are rare, but most of them are invasive pituitary macroadenomas, in which patients show obvious symptoms of hyperthyroidism and diffuse goiter. TSH, T3 and T4 are significantly increased in the blood.
(5) Gonadotropin (GnH) adenoma: Most often found in middle-aged men, the main symptoms are tumor compression symptoms: headache, visual dysfunction, and hypopituitarism. Although the function of the gonads themselves is mostly normal, hypogonadism can occur in both men and women.
Clinical manifestations of non-secretory pituitary adenoma are mostly seen in adult males. It grows slowly and is often seen when the tumor is large. The tumor compresses the pituitary gland and produces symptoms of hypopituitarism, which manifests itself as hypogonadism, impotence and obscure secondary sexual characteristics in men. In women, the symptoms are amenorrhea and infertility. Some patients may have mild or moderate prolactinemia due to the lack of dopamine suppression of PRL secretion due to pituitary stalk compression, in which case blood PRL rarely exceeds 100 μg/L. Growth hormone pituitary adenomas that develop before puberty result in “gigantism”.