Overview] Pituitary adenoma is a benign adenoma, with about 1 case in 100,000 people, and there is a tendency for it to increase in recent years, especially in women of childbearing age. Beijing Institute of Neurosurgery reported that pituitary adenoma accounted for 12.2% of intracranial tumors. Clinical manifestations] Pituitary gland is an important endocrine organ, containing several kinds of endocrine cells, secreting many kinds of endocrine elements, and if a certain endocrine cell grows into an adenoma, special clinical manifestations may occur. The details are described as follows: 1. Endocrine manifestations of different kinds of pituitary adenomas (1) Growth hormone cell adenoma: the tumor is only a few millimeters in size in early stage, and it mainly manifests as excessive secretion of growth hormone. Underage patients may have overgrowth and even develop into giants. In adults, the tumor manifests as hypertrophy of limbs. For example, the face changes, forehead becomes bigger, jaw protrudes, nose is big and lips are thick, fingers become thicker, shoes and hats feel tight, and larger models are changed several times or even have to be specially made, and some patients have more meals, rough hair and skin, pigmentation, numbness of fingers, etc. In serious cases, patients feel weak all over the body, and have a feeling of fatigue. In severe cases, there is generalized weakness, headache and joint pain, hypogonadism, amenorrhea and infertility, and even diabetes mellitus. (2) Prolactin cell adenoma: It mainly manifests as amenorrhea, breast overflow, infertility, and in severe cases, loss of armpit hair, pale and delicate skin, increase of subcutaneous fat, and fatigue, fatigue, lethargy, sleepiness, headache, and hypogonadism, etc. In men, it manifests as hypogonadism. In men, it is manifested as decreased libido, impotence, mammary gland hyperplasia, scanty beard, atrophy of reproductive organs in severe cases, decreased sperm count, infertility, etc. There are not many cases of male-to-female degeneration. (3) Adrenocorticotropic hormone cell adenoma: clinical manifestations are centripetal obesity, full-moon face, buffalo back, polycythemia, abdominal and thigh skin with purple lines, and increase of cui-lii hair. In severe cases, amenorrhea, loss of libido, generalized weakness, and even bedridden. Some patients have hypertension, diabetes and so on. (4) Thyroid-stimulating hormone cell tumor: rare, due to over secretion of thyroid-stimulating hormone from the pituitary gland, causing hyperthyroidism, and hyperthyroidism disappears after removal of the pituitary tumor. In other cases, hypothyroid feedback causes focal hyperplasia of the pituitary glands, which gradually develops into pituitary adenomas, which may cause enlargement of the pyriform saddle and compression of nearby tissues. (5) Follicle-stimulating hormone cell adenoma: It is very rare, and only a few cases have been reported with hypogonadism, amenorrhea, infertility, and decreased sperm count. (6) Melanin-stimulating hormone cell adenoma: very rare, only a few patients reported to have black skin, not accompanied by increased cortisol. (7) Endocrine inactive adenoma: Early patients have no special feeling that the tumor is growing, and it may compress the pituitary gland and cause the clinical manifestation of pituitary insufficiency. (8) Malignant pituitary tumor: with short history and rapid progression of disease, not only the tumor grows up and presses the pituitary tissue, but also invades to the surrounding area, resulting in the destruction of the saddle base bone or infiltration into the cavernous sinus, which causes the palsy of the motor nerve or the paralysis of the abducens nerve. Sometimes, the tumor penetrates the saddle base and grows into the pterygoid sinus, but the neurological symptoms are not obvious in a short period of time. Visual field disorder: Early pituitary adenoma often has no visual field disorder. If the tumor grows and extends upward, compressing the optic forks, visual field defect will appear, and the outer upper quadrant will be affected firstly, and the red visual field will be shown firstly. The red field of vision is the first to be affected. Later, the white field of vision will also be affected when the lesion increases in size and the compression is more severe, and the visual field will gradually be expanded to bilateral temporal hemianopsia. If the disease is not treated in time, the visual field defect can be further enlarged and the visual acuity can be reduced, resulting in total blindness. Because most pituitary tumors are benign, the initial lesion may last for quite a long time, and when the condition is serious, the visual field impairment may be aggravated suddenly, and if the tumor is on one side, it may lead to monocular hemianopsia or blindness. Other neurological symptoms and signs: if the pituitary tumor grows backward and upward and presses the pituitary stalk or hypothalamus, it may cause polydipsia and polyuria; if the tumor grows laterally and infringes on the wall of cavernous sinus, then there will be paralysis of the motoneuron or the abducens nerve; if the tumor passes through the saddle septum and then grows upward and causes the ventral part of the frontal lobe, then sometimes there will be psychiatric symptoms; if the tumor grows backward and upward and obstructs the anterior part of the third ventricle and the interventricular foramen, then there will be symptoms of increased intracranial pressure, such as headache and vomiting. If the tumor grows backward and blocks the anterior part of the third ventricle and the interventricular foramen, symptoms such as headache and vomiting will occur. If the tumor grows backward, it may compress the brainstem and cause coma, paralysis or brain ankylosis. Clinical manifestations of pituitary tumor Pituitary tumor mostly occurs in young adults aged 20 to 50 years old, and it is rare in old age, especially in children, and the incidence rate of men and women is roughly equal. Clinical manifestations of pituitary tumor may include one or more of the following: 1. Headache. 2. 2, vision field changes (one eye or both eyes can not see things clearly, easy to hit the door frame, and in severe cases, it gradually develops to blindness or sudden headache blindness) 3, menstrual disorders, menopause, lactation (spontaneous milk flow from the breasts or after touching the breasts to flow milk), inability to get pregnant, sexual desire sexual ability changes (mostly hypogonadism), body hair reduction, skin changes (thinning) 4, acromegaly: hands and feet, head, thorax, and limb Progressive enlargement, hypertrophy of palms, thickening of fingers, spherical shape of distal end, bulging of forehead, obvious protrusion of orbits, zygomatic bone or jaw, widening of teeth gap, thickening of mouth and lips, wide and flattened bridge of nose, enlarged ears, frequent use of hats, shoes, socks and gloves [Auxiliary Examination] How to find out the pituitary tumor at an early stage? How to detect pituitary tumor at early stage? It should be noticed after the appearance of relevant symptoms, such as doing a CT examination, and then after more detailed MRI examination, it can be clarified. Generally speaking, endocrine obvious change after treatment is ineffective, or the appearance of headache, visual impairment, endocrine any one of them should be taken into consideration, and if they appear at the same time, they should go to the examination in time. Pituitary tumor usually occurs in women aged 20-40 years old, because women have more hormonal changes and fluctuations during their lifetime. 1.Endocrinology examination: Measurement of growth hormone, prolactin, adrenocorticotropic hormone, thyroid-stimulating hormone, melanin-stimulating hormone, follicle-stimulating hormone, luteinizing hormone of the pituitary gland, etc., which is of great help to the early diagnosis of pituitary adenoma. (2) Radiologic examination (1) Pterygoid image: It is one of the basic examinations. When the pituitary tumor is small, the pyriform saddle can be unchanged. As the tumor grows up day by day, the pyriform saddle can be enlarged, the bone can be destroyed, and the saddle back can be eroded. (2) CT scan: after enhancement with intravenous contrast medium, a pituitary adenoma of 5mm in size can be demonstrated. Smaller tumors are still difficult to show. (3) Cranial magnetic resonance imaging (MRI) scan (scanning and enhancement): it is the most accurate imaging examination for diagnosing pituitary tumor, and most of the pituitary adenomas can be clearly diagnosed by cranial MRI examination. Therapeutic measures: 1. Surgery: mainly including craniotomy and transsphenoidal surgery. 2. 2.Radiation therapy: ordinary radiotherapy has certain effect on pituitary adenoma, which can only control tumor development and sometimes make the tumor shrink, resulting in the improvement of visual field, but it can not be cured fundamentally; only the head gamma knife treatment is the root cause of pituitary tumor. 3.Drug therapy: Bromocriptine is a semi-synthetic ergotamine alkaloid, which can stimulate the dopamine receptor of pituitary cells to reduce the effect of prolactin in blood. After taking bromocriptine, prolactin adenoma can be reduced in size, menstruation and ovulation can be resumed and fertilization can be restored, and pathological breast overflow can be suppressed, but bromocriptine can not cure prolactin adenoma fundamentally, and it can continue to increase in size after stopping the drug, and the symptoms will appear again. In addition, bromocriptine can also reduce the symptoms of growth hormone cell adenomas, but the dosage of the drug is large and the efficacy is poor. At present, this kind of minimally invasive surgery is being carried out in some provincial hospitals and large hospitals with advanced equipment. Will the tumor recur after treatment? Objectively speaking, any tumor may recur, only benign tumors have a relatively long time to recur, for example, after ten or twenty years. If the surgery is thorough and there is no residual root, it is very difficult to recur. The recurrence of pituitary tumor is usually 10-20 years or even longer under the premise of complete removal. For middle-aged people, one operation may be enough, and young people can have a second operation later after one operation. Pituitary tumor causing vision loss Pituitary tumor in the pterygoid saddle can break through the saddle bottom and grow downward, and invade important blood vessels and nerves in the cranium on both sides. However, the most common way of growth is to develop upward toward the saddle and compress the optic cross and optic nerves, which causes vision loss and visual field loss, and the patient often complains of loss of vision, not being able to see the two sides, and always bumping into the door side. Patients often complain of vision loss, not being able to see both sides of the room, and always bumping into doors. Surgery is needed as soon as possible to remove the compression on the optic nerve and save vision when visual field impairment occurs. If it is accompanied by growth in other directions, it is called invasive pituitary adenoma, which is significantly more difficult to treat, and it is difficult to remove it at one time, so it is necessary to adopt individualized treatment according to the specific situation.