Pituitary adenomas occur in young adults and cause severe damage to the patient’s growth, development, work capacity, reproductive function, and psychology. The population prevalence is 1 per 100,000 and the autopsy detection rate is 20% – 30%. In the past half century, especially in the past two decades, with the clinical application of pituitary hormone radioimmunoassay, CT and MR and people’s deeper understanding of pituitary adenoma, the incidence of pituitary adenoma has increased year by year.
1. According to the size of pituitary adenoma, it can be divided into: (1) microadenoma (diameter <1.0cm) (2) macroadenoma (diameter >1.0cm) (3) giant adenoma (diameter >3.0cm).
2, according to immunohistochemical techniques: pituitary adenoma can be divided into (1) lactogenic cell adenoma; (2) growth hormone cell adenoma; (3) adrenocorticotropic cell adenoma; (4) thyrotropin cell adenoma; (5) folliculopoietin cell adenoma; (6) luteinizing hormone cell adenoma; (7) multifunctional cell adenoma; (8) non-functional cell adenoma.
Clinical manifestations】 1. Headache: About 2/3 of patients have headache in the early stage, often located in both foreheads, forehead, or behind the eyes, with intermittent attacks or persistent vague pain.
2. Visual impairment: most of the vision loss starts from one side. The vision loss can be progressive or rapidly developing. Late stage vision loss is caused by optic nerve atrophy due to tumor compression of optic nerve.
3.Tumor compression local: it can affect abducens nerve or motoneurotic nerve and cause inward slanting of the affected eye or ptosis, pupil dilatation and eye fixation; tumor extends forward to temporal lobe and can cause epilepsy and psychiatric symptoms; tumor develops significantly to the saddle and can affect hypothalamus and cause drowsiness, hyperphagia, obesity, abnormal behavior and other symptoms; tumor develops to pterygoid saddle and nasal cavity and can cause nasal bleeding and cerebrospinal fluid nasal leakage.
Diagnosis】 Pituitary adenoma can be diagnosed based on clinical manifestations and related auxiliary examinations. The clinical symptoms of pituitary adenoma include pituitary dysfunction and pressure on the adjacent structures of pituitary gland. Patients with clinical symptoms such as amenorrhea, lactation, infertility, impotence, sexual dysfunction, manifestations of excessive body growth, acromegaly, increased cortisol, visual field impairment, optic papillary atrophy in the fundus, and headache should be considered as having pituitary adenoma, and further endocrine examination and neuroimaging are needed to confirm.
Treatment】 Mainly includes drug therapy, radiotherapy and surgery. At present, most pituitary adenomas can be removed through unilateral nasal – pterygoid sinus approach, which has the following advantages: minimal trauma, less blood loss, short operation time, less pain for the patient, fast postoperative recovery, and short hospital stay.