Pituitary tumor is a common benign intracranial tumor with an incidence rate of 1 per 100,000, accounting for 10% of intracranial tumors and ranking 3rd. The age of predilection is young adults, the onset of disease is slow, and it is rarely malignant.
Clinical manifestations of pituitary tumor
Compression symptoms.
Headache, early 2/3 of patients have headache, mild, intermittent attacks.
Visual field impairment.
The tumor compresses the pituitary stalk and hypothalamus backward, manifesting as uveitis and hypothalamic dysfunction; involvement of the third ventricle, interventricular foramen, and aqueduct may cause symptoms of increased intracranial pressure, to the frontal lobe may cause psychiatric symptoms, epilepsy, and olfactory disturbance.
Endocrine symptoms.
Prolactin adenoma.
Increased prolactin and decreased estrogen may cause amenorrhea, lactation, and infertility; hypopituitarism may show weakness, drowsiness, hypogonadism, mental abnormalities, hair loss, obesity, etc. PRL>100ug/IL (normal, <20ug/L in men, <30ug/L in women)
Growth hormone adenoma.
Increased growth hormone, can cause acromegaly, gigantism; hypogonadism, amenorrhea, infertility; sleep apnea syndrome due to sleep collapse on hypertrophic tongue and throat, etc. GH5-10ug/L, 90% above 10ug/L (normal 2-4ug/L)
Adrenocorticotropic adenoma.
Manifestation of Cushing’s syndrome, centripetal obesity, full moon face buffalo back, hypogonadism or infertility, etc., urinary free cortisol (UFC) >100ug is diagnostic (normal 20-80ug/24).
Thyroid-stimulating hormone cell adenoma.
Due to increased TSH secretion T3 and T4 are increased and show symptoms of hyperthyroidism.
Gonadotropin cell adenoma.
Hypogonadism, amenorrhea, infertility, etc.
Current treatments for pituitary tumors
Surgery: Surgery is the preferred treatment for pituitary macroadenomas. Only prolactinomatous or nonsecretory microadenomas are considered for drug treatment and observation and follow-up. Those who have incomplete surgery need to be treated with radiotherapy and medication, and if necessary, surgery again. Recurrence after surgery is related to the following factors: ① incomplete surgical resection, tumor tissue remnants ② aggressive tumor growth, involving the dura, cavernous sinus or bone tissue ③ multiple pituitary microadenoma, ④ pituitary cell hyperplasia.
Western medicine treatment is only effective in some cases. For example, bromocriptine for PRL adenoma, GH adenoma, ACTH adenoma, growth inhibitor or estrogen for GH adenoma, cycloheximide, mepyrone for ACTH adenoma, non-functional adenoma and pituitary hypoplasia, various hormone replacement treatments are used, all of which are palliative and can relieve symptoms to varying degrees, but cannot be cured at all, and the symptoms recur and the tumor continues to grow after stopping the medication.
Radiation therapy: It is applied to pituitary adenomas and pituitary cancers with incomplete surgery or possible recurrence. X-knife and R-knife are applied to tumors less than 3 cm. Although radiation therapy for pituitary adenomas has certain efficacy, further studies on its dose, efficacy, and damage to pituitary hypoplasia, optic cross-optic nerve, and peripheral vascular nerve structures are still needed in clinical practice.
Transnasal-disc surgery for pituitary tumors has a wide range of indications, low surgical risk, and good efficacy and is indicated for more than 75% of pituitary tumor patients. However, transnasal surgery requires high surgical skill and accurate knowledge of local anatomy, and is yet to be widely performed.