[Q]: Brain tumors are relatively rare among the tumors of the whole body, but we often hear that some of our acquaintances have pituitary tumors.
[A]: Compared with other tumors, brain tumors are indeed relatively low in the occurrence of tumors in the whole body. Among all brain tumors, pituitary tumors are the third most common. About 15% of the patients in our hospital beds require surgery. With the development of economic level, pituitary adenomas are more easily detected. For example, we now have very advanced magnetic resonance instruments that can detect very small tumors. If we get 20 healthy adults to go for an examination, we will find that 2 of them have some alteration of the pituitary gland, but in this group there is no serious clinical manifestation or impact on life. We find that there are more patients with pituitary adenomas, but fewer of them require clinical management.
[Q]: What are the characteristics of pituitary adenoma?
[A]: It is determined by the size and nature of the tumor. Generally speaking, the tumor grows gradually and the symptoms associated with it after it grows up, let’s say the tumor is small and grows slowly because there is a small room in the pituitary gland and the pressure is high after this small room is full, so these patients will have headache in early stage. If the tumor grows further and breaks through the roof of the small room (called “saddle septum” in medical science), if it grows to a certain extent, it will affect the optic nerve. The first symptom is that the vision is worse than before, and it will tell us that it is becoming more and more unclear to see things, and it is doubtful whether it is myopia or presbyopia. As the tumor presses on the optic nerve, the visual field will be narrowed, so the tumor will grow to a certain extent and press on the optic nerve, which will affect the change of vision and visual field.
The second part is very important, this part of pituitary adenoma actually we divide it into two categories. For example, if a girl has a prolactin adenoma, her menstruation will stop, her menstruation will be disrupted, or she will secrete milk, so we should have a high suspicion of high prolactin or prolactin adenoma in the brain. This is based on the nature of the hormone and the tumor to determine the clinical performance. We once had a patient who had a pituitary adenoma, and after he was discharged from the hospital, his neighbor found that he might have pituitary adenoma, which manifested as enlarged limbs, big face, big hands, big feet, etc. We call it a growth hormone cell growth tumor called growth hormone adenoma. This is called a growth hormone adenoma. If the tumor occurs in children or before adulthood, it can lead to gigantism. Indeed, we have seen some patients with adenomas when they were young and they reached 2.2 meters or 2.3 meters in size.
The third type of symptoms is when it is not the secretory cells that grow out of the tumor and press the normal pituitary gland, so that the normal endocrine function is low and another type of symptoms will appear. These two symptoms are very typical: weakness and poor appetite. In this case, we found that a tumor has grown inside the pituitary gland in the brain. When we check the endocrine system, many hormones are low, so in general, if a tumor grows, these three symptoms will appear.
If the above situation occurs, you can go to the hospital to see, only the correct diagnosis can have the correct treatment.
[Q]: What is the best way for patients to know if they have pituitary adenoma?
[A]: Pituitary adenoma is an endocrine-influenced tumor, and the oncological features can have extrusion on other nerves. It has a scattered manifestation and affects all systems of the body, so we are divided into different departments, if the popular common sense, normal reproductive women, not in lactation have lactation, we should pay attention to it, our hospital is a certain knowledge of each department, they will choose different tests according to different people, such as magnetic resonance examination, etc., so to diagnose a pituitary adenoma in the early stage Check out, if you suspect it, you have to check. One is endocrine examination, let’s say the pituitary adenoma itself secretes altered hormones, and normal hormones are declining, and the second is urine examination.
[Q]: Is it possible that someone has pituitary adenoma, but does not show any symptoms?
[A]: There are cases of small non-secretory adenomas, the incidence of which is much higher than we think, like some large volume experiments abroad, they can find some small adenomas, which are clinically asymptomatic. At the same time, there are some patients who can be encountered in the outpatient clinic because of other reasons, such as a fall, or a physical examination, it has no symptoms, but after going to the investigation, there is a small tumor in the pituitary gland, our doctors will check it, and once the endocrine examination, it is normal, we will tell it is a non-secretory adenoma. If the adenoma is found to be very slow growing, we say that it is clinically asymptomatic.
[Q]: Under what circumstances can a benign pituitary tumor become malignant?
[A]: The incidence of pituitary adenomas is very high, and all of them are benign. However, there is also pituitary adenocarcinoma, which is malignant and can metastasize. The good thing is that the incidence of such cases is very low, so far, there are less than 100 cases worldwide.
[Q]: The incidence of pituitary adenoma is so high in the population, which ones need to be treated?
[A]: In fact, treatment depends on the nature of the tumor and the size of the tumor. Generally speaking, if the patient is found to be a pituitary tumor, we should first look at the nature of the pituitary tumor, if it is a secretory tumor, the purpose of our treatment is to correct its endocrine function. The first one is non-surgical treatment. This treatment is non-operative, but not all pituitary adenomas can be treated with medication. For pituitary adenomas that require medication, such as lactogenic pituitary adenomas, medication is very effective. There is another type of pituitary adenoma that is not a prolactin adenoma, but a small adenoma that is secretory in nature, which should not be treated with drugs. As for large adenomas, the current progress in surgery is very fast, especially the progress in minimally invasive surgery and microsurgery. If we are not sure about the diagnosis of the patient, we will continue to observe.
For treatment, we divide it into three aspects: surgical, non-surgical, and observation.
[Q]: Is oligocryptine the most common drug treatment? Are there any side effects?
[A]: I think it is the most ideal method to treat tumor with medication. If there are no side effects, this is the goal of medical research. In general, the effect of treatment is relatively clear, no matter it is pituitary tumor, as long as after the doctor’s examination, we confirm that it is a prolactin adenoma, first of all, drug treatment, drug treatment is effective for small and large tumors, but not all of them are effective, special cases also need to use surgery. 70% of the patients have improved after using drugs, and some patients have endocrine improvement, etc. are not satisfactory, now there is a new drug Now, a new drug has been developed, and this group of patients who have taken cryptocryptine is not satisfactory, and with the new drug, they may achieve the purpose of reducing the endocrine level. In general, through more than 30 years of practice, cryptocryptine is a very safe drug and is the treatment of choice for prolactin adenoma.
[Q]: Under what circumstances does a patient still need radiation therapy?
[A]: When it comes to radiotherapy, we cannot help but review the history of radiotherapy in pituitary tumor treatment. Secondly, after six months and one year’s visit, we measured an endocrine hormone, and its function is getting lower and lower, which is also caused by radiation therapy, so radiation therapy has some possible complications. If the tumor is completely removed, we think the future radiotherapy is not necessary. If there is residual, we will continue to observe, for example, after the first surgery, we have removed the lower part of the tumor and found that the upper part is still developing. During the observation process, there is no way to operate on these tumors, if they continue to grow, we will use radiation therapy, we are talking about external radiation, we will control it very strictly, of course, radiation therapy also includes part of gamma knife treatment, it also has some effect on the relatively small pituitary gland, but it is not the only means that can replace other methods.
[Q]: Minimally invasive surgery is now prevalent in all surgical fields, is pituitary tumor surgery minimally invasive?
[As the people’s living standard is improving, the demand for medical treatment is getting higher and higher, and the medical industry is advocating the concept that you should operate on the patient, but try to make it as non-invasive as possible. At present, in China, pituitary adenoma surgery is performed in the better hospitals, we do 100 pituitary tumor patients, 90%-95% of them are operated under the microscope. The vast majority of pituitary tumors are minimally invasive, but the theme of our year is early diagnosis and early treatment of pituitary tumors, some of which are very difficult to treat, and serious surgical microsurgery is also minimally invasive, but the impact is also very significant.
[Q]: Is pituitary tumor surgery risky? How long can I go to work after pituitary tumor surgery?
[A]: After the surgery, we are all concerned about the risks and problems during the surgery, and we will introduce two aspects in detail for each pituitary tumor patient. Secondly, what kind of complications will occur after the surgery, this is also a concern for everyone, because the tumor is minimally invasive and we have removed all the tumor, there will be more common complications. One is to urinate a lot after the tumor is removed, because we have dug the pituitary tumor cleanly and dug the normal posterior pituitary fluid, so there will be more urination and dry mouth.
The second complication is that if the tumor is relatively large and the tumor is completely removed, there may be fluid leaks. The most common complication is the occurrence of these complications, of course, there are also some large tumors that have been pressed for a long time, the function may still be poor after resection, these are still there, we have to supplement some necessary factors in the long term, the pituitary gland regardless of transnasal, open cranial surgery, etc., the surgical techniques are very mature, the risk is still relatively low.
[Q]: What is the best advice for pituitary tumor patients who are ready for surgery?
[Luo Jun]: For patients who have been diagnosed with pituitary tumor, they definitely need surgery under the recommendation of their doctors. For pituitary tumor surgery, we have seen from the statistics and observations at home and abroad that the effectiveness of surgery depends on the early and late detection, type, etc. Theoretically, it is impossible to cut cleanly. In addition, we are concerned about its complications, and these results show that there is basically a consensus in Europe, the United States and China that we should go to hospitals that perform more than 50 pituitary tumor surgeries per year, because if a hospital does less, even if the technology is very good, it will be born. But the treatment of pituitary tumor is benign, so don’t worry very much, make a choice when you have time and choose a hospital with rich experience to do it.
[Q]: If a pituitary tumor has been operated on, can it recur?
[If the tumor is removed until the tumor is invisible on imaging, and if the endocrine examination is normal, there is almost no recurrence. If the tumor is invasive, it seems to have no complete boundary, if it grows to other places, it is very difficult to remove it completely, if the tumor grows to other places, and it is invasive, it is very difficult to remove the tumor completely, then the so-called recurrence rate, we have to see if the tumor is completely removed, and then the tumor is found to grow again, this situation is rare, if the tumor still has a part of residual, some may not grow immediately. If you have a good quality of life and you have a tumor, you don’t have to worry about it, if it grows gradually during our observation, we will further deal with it, if it is a large tumor, its recurrence rate is higher, it will be more than 20%, this should be seen during the follow-up process, if we do treatment again. We will choose the most suitable treatment according to the patient’s condition, the location of the tumor and the size of the tumor.
[Q]: What are the characteristics of pituitary tumor treatment in Long March Hospital?
[A]: Firstly, it has a relatively good team. Secondly, we have a long history of pituitary tumor surgery in neurosurgery, since the 1980s, we have been doing more than 2,000 surgeries, and now there are more than 150 surgeries per year, so we have a good accumulation. Thirdly, we are able to provide standardized treatment for pituitary tumors in accordance with international standards, while at the same time adopting individualized treatment plans for patients according to their specific conditions.