Clinically, pituitary tumors ≤10 mm in diameter are referred to as pituitary microadenomas.
1.Discovery of tumor: pituitary microadenoma is basically diagnosed by imaging (CT or MRI) examination, combined with clinical symptoms to determine the diagnosis.
2.Tumor intervention: If you suspect you have pituitary microadenoma, you do not need to be overly nervous because even if it is diagnosed, this tumor is a benign tumor, and the tumor is very small and usually only causes some symptoms of endocrine changes inside the body and is not directly life-threatening.
3. Although the same pituitary microadenoma is present, the clinical manifestation varies because of the different endocrine types. While the normal pituitary gland secretes seven hormones, there are basically only three types of common microadenomas, which are expressed in the following headings.
Prolactin (PRL) microadenoma
This tumor accounts for the majority of pituitary microadenomas. In case of clinical suspicion of endocrine symptoms, such as menstrual irregularities, amenorrhea and lactation, infertility and decreased libido in women and decreased sexual function and impotence in men, women can first see an endocrinologist in the gynecology department, or they can visit the endocrinology department, where an experienced doctor will arrange for you to have relevant tests, usually blood tests for relevant hormones and imaging tests for magnetic resonance imaging (MR) plain scan + dynamic enhancement. CT examinations are usually not recommended.
After getting the initial diagnosis, what you should do is to go online to learn about pituitary microadenoma, but it is sometimes difficult to distinguish between true and false internet knowledge, so we recommend you to consult with the neurosurgery department of a large hospital.
Treatment.
1. Drug therapy is preferred. This is a traditional mode of selection. Women of childbearing age, with corresponding symptoms, and after blood sampling for prolactin and imaging for pituitary microadenoma, can generally be treated with oral dopamine agonist-bromocriptine after diagnosis, and the efficacy can be determined by scientific tracking and monitoring the effect of medication and clinical observation of menstruation and conception success rate. Some patients experience headache, dizziness, gastrointestinal reactions, constipation and other symptoms during bromocriptine administration, which can be alleviated by gradually increasing the dosage starting from small doses, or the less common way of vaginal administration can be chosen. New generation dopamine receptor agonists such as: dihydroergotocryptine Crepa can be used as an alternative.
2. Transsphenoidal sinus surgery. This is the treatment that is the focus of this article. Transsphenoidal surgery itself is not new, but new in terms of progress. In the last decade, with the advances in diagnostic techniques, the large number of selected surgical cases, the emergence of professional pituitary surgeons, and the application of high-end microscopes, the views and conclusions of surgical treatment have changed considerably, and where all of the above conditions are available, the rate of complete microadenoma resection and postoperative hormone normalization have reached a fairly high level, usually 80-90%, and basically The surgical mortality and major accident rates have been largely eliminated.
However, not all general neurosurgeons are competent in this procedure, because transsphenoidal surgery is different from conventional craniotomy, and pituitary microadenoma also involves too many gynecological and endocrinological problems.
For those patients who wish to achieve a radical cure of the tumor, and for women of childbearing age with a tumor that clearly affects fertility, surgery may be actively considered in order to obtain a good outcome and eradicate the disease.
Growth hormone (GH) microadenomas
Because growth hormone adenomas are usually found when the tumor has exceeded the size of a “microadenoma”, and because some suspected “growth hormone microadenomas” are more complicated to diagnose, the proportion of these tumors in clinical statistics is small.
1.Surgical treatment is preferred. Surgical treatment is expected to achieve the eradication of the tumor or greatly reduce the level of hormone secretion of the tumor.
2. Drug treatment. Growth hormone mimetic drugs, such as lanreotide and octreotide, etc. These drugs can reduce blood GH and IGF-1 levels in some patients, and reduce tumor size and improve patients’ symptoms, but they do not cure the tumor. Moreover, these drugs are expensive and may be difficult for patients to afford.
3.Radiation therapy. General radiotherapy has gradually not been routinely recommended. Gamma knife treatment can be recommended for patients with contraindications to surgery, or for patients who have concerns about surgical treatment. However, recent studies have obtained clear data on the long-term radiological “pituitary tumor hypofunction”, so it is important to fulfill the obligation to inform patients before treatment.
Adrenocorticotropic hormone (ACTH) microadenomas
This is a group of diseases for which the concept of treatment has changed considerably in recent years. The introduction of surgical treatment offers great hope for the cure of these patients, given that the disease was formerly known as an almost incurable disease.
Because of the complexity of the endocrine pathology, it is best to obtain a clear diagnosis in the endocrinology department, and when combined with the imaging of the occupying features, the patient can usually expect a “springtime” outcome with surgery. “The patient’s choice of surgical treatment is usually expected to yield the desired outcome.
Several misconceptions about pituitary microadenoma treatment
1, pituitary prolactin adenoma (PRL): Worry about “affecting fertility” after surgery, in fact, just because the tumor itself has already affected fertility, surgery is a means to correct this effect, and the effect of surgery itself will only be caused when the surgery does not go well, such as in case of accidents, but experienced specialists have already controlled this effect to a minimum. Professor Xu Guangming of Shandong Provincial Hospital said, “As long as the doctor’s skills and responsibility are in place, there should not be any major medical accidents”. The First Hospital of Jinan University has completed hundreds of microadenoma surgeries without a single death or major surgical accident, which also shows that the safety of the surgery is highly guaranteed.
2, overemphasizing the superiority of endoscopy: Patients do not have to choose a surgeon who uses different surgical instruments, but only a surgeon who is specialized in pituitary tumors and has a sense of responsibility. As I have emphasized in several articles, the use of microscope and endoscope are only different means of surgery, each having its own characteristics. This is illustrated by the fact that most of the leading pituitary tumor specialists in the country use microscopes.