The pituitary gland is a tiny gland located in the pituitary fossa of the saddle at the base of the skull. It is divided into two lobes, anterior and posterior, and is an important endocrine organ containing several types of endocrine cells that secrete a variety of endocrine hormones. (TSH), etc.; the posterior lobe mainly stores anti-diuretic hormone (ADH) and oxytocin, which are secreted by the hypothalamus. Therefore, it is extremely relevant to human healthy life.
Pituitary tumors are benign adenomas originating from the pituitary gland and are quite common, with an increasing trend in recent years, especially in women of childbearing age. They account for 12.2% of intracranial tumors. In case of a particular endocrine cell growth adenoma, specific clinical manifestations can occur.
Their details are described separately as follows.
1. Endocrine manifestations of different kinds of pituitary adenomas
(1) Growth hormone cell adenoma: The main manifestation is excessive secretion of growth hormone. In adolescent patients, excessive growth may occur and even develop into giants. In adulthood, it is a manifestation of acromegaly.
(2) Prolactin cell adenoma: The main manifestations are amenorrhea, overflow of milk, sterility, loss of axillary hair, pale and delicate skin, increased subcutaneous fat in severe cases, as well as weakness, easy fatigue, drowsiness, headache, and hypogonadism. In men, the symptoms include loss of libido, impotence, breast enlargement, beard thinning, atrophy of the reproductive organs, reduction of sperm count, and infertility, etc. There are not many male and female patients.
(3) Adrenocorticotropic hormone cell adenoma: Clinical manifestations are centripetal obesity, full-moon face, buffalo back, polycythemia, purple lines on the skin of abdomen and thighs, and increased fine hair. In severe cases, amenorrhea, loss of libido, general weakness, and even bedridden. Some patients also have hypertension, diabetes, etc.
(4) Thyroid-stimulating hormone cell tumor: Rarely, hyperthyroidism is caused by the overproduction of thyroid-stimulating hormone in the pituitary gland, and the symptoms disappear after the pituitary tumor is removed. The symptoms of hyperthyroidism disappear after removal of the pituitary tumor. There are also cases of focal hyperplasia of the pituitary gland caused by hypothyroidism feedback, which gradually develops into pituitary adenoma.
(5) Follicle-stimulating hormone cell adenoma: It is very rare, and only some individuals report clinical hypogonadism, amenorrhea, infertility, and reduced sperm count.
(6) Melanin-stimulating hormone cell adenoma: Very rare, only a few patients reported black skin pigmentation without cortisol increase.
(7) Endocrine inactive adenoma: In the early stage, the patient has no special feeling that the tumor is growing and can compress the pituitary gland causing clinical manifestations of pituitary insufficiency.
(8) Malignant pituitary tumor: the disease history is short and the disease progresses rapidly. Sometimes the tumor penetrates the saddle base and grows into the pterygoid sinus, and the neurological symptoms are not obvious for a short period of time.
2.Visual field disorder: Early pituitary adenoma often has no visual field disorder. If the tumor grows up and presses the visual cross, visual field defect will appear, and later the lesion will increase and the defect can be expanded to bilateral temporal hemianopia. If left untreated, the visual field defect may expand further and the visual acuity may be diminished to total blindness. Because pituitary tumors are mostly benign, the initial lesions can last for a considerable period of time, and when the condition becomes severe, the visual field impairment can suddenly increase, and if the tumor is on one side, it can lead to monocular blindness or blindness.
If the tumor grows posteriorly and obstructs the anterior part of the third ventricle and interventricular foramen, headache, vomiting and other symptoms of increased intracranial pressure will appear.
Clinical manifestations of pituitary tumor Pituitary tumor mostly occurs in young adults aged 20 to 50 years old, and is rare in the elderly, especially in children, with roughly equal incidence in men and women. The clinical manifestations may be one or more of the following: 1. Headache. 2. Visual field changes (monocular or binocular vision is unclear, easy to hit the door frame, and in severe cases gradually progress to blindness or sudden headache blindness) 3. Menstrual disorders, menopause, lactation (spontaneous milk flow from the breast or milk flow after touching the breast), inability to conceive, changes in libido sexual ability (mostly hypogonadism), reduction in body hair, skin changes (thinning) 4. Acromegaly: hands and feet, head, thorax and limbs Progressive enlargement, hypertrophy of palms, thickening of fingers, spherical distal end, bulging forehead, protruding orbits, cheekbones, i.e., jaws, widening of teeth, thickening of lips, broad and flattened nasal bridge, enlarged ears, hats, shoes and socks, gloves often
How can pituitary tumors be detected early?
It should be taken seriously after the appearance of related symptoms, such as a CT examination, and then after a more detailed MRI examination, it can be clarified. Generally speaking, those with obvious endocrine changes that have not worked after treatment, or those with headaches, visual impairment, or any of the endocrine should be considered, and if they occur at the same time, they should be promptly examined. Pituitary tumors are usually found in women aged 20-40 years old, because women have more hormonal changes and fluctuations during their lifetime.
1.Endocrinological examination: The application of endocrine radioimmuno-ultra-microscopic method to directly measure growth hormone, prolactin, adrenocorticotropic hormone, thyroid-stimulating hormone, melanin-stimulating hormone, follicle-stimulating hormone and luteinizing hormone in pituitary gland is very helpful for early diagnosis of pituitary adenoma.
2.Radiological examination
(1) Pterygoid flat film: It is one of the basic examinations. When the pituitary tumor is small, there can be no change in the saddle, but as the tumor grows, the saddle can be enlarged, the bone is destroyed and the saddle back is eroded.
(2) CT scan: After enhancement with intravenous contrast, it can show pituitary adenoma of 5mm in size. Smaller tumors are still difficult to show. (3) MR scan: Scanning the pituitary area from a three-dimensional angle can clearly show whether there is enlargement of the pituitary gland, whether there is deviation of the pituitary stalk, and whether there is abnormal inhomogeneous enhancement after enhancement, thus confirming the diagnosis of pituitary tumor.
Treatment measures
1.Surgical treatment: It mainly includes craniotomy and treatment by transnasal approach. Transnasal approach surgery is widely used because it does not destroy the appearance of the nose, does not open the skull, has little impact on brain tissue, and is simple, less traumatic and safer. Craniotomy is suitable for huge, invasive growth to the surrounding, and the transnasal approach resection can not release the occupying effect.
2.Radiotherapy: Radiotherapy has certain effect on pituitary adenoma, especially for micro tumors, cases where patients are afraid of surgery and supplementary treatment programs for pituitary tumor remnants after surgery.
3.Medication: Bromocriptine is a semi-synthetic ergotamine alkaloid, which can stimulate the dopamine receptors of pituitary cells to reduce the effect of prolactin in blood. Bromocriptine can reduce the size of prolactin adenoma, restore menstruation and ovulation and conception, and suppress pathological overflow of breast milk.
Will this procedure recur after treatment?
Objectively speaking, any tumor may recur, but benign tumors have a relatively long time to recur, for example, after ten or twenty years. Surgical removal is very thorough and combined with stereotactic emission therapy, the recurrence rate is usually very low. With long-term follow-up, secondary surgery can be performed after recurrence. Pituitary tumor causing vision loss
Pituitary tumors in the saddle can break through the saddle base and grow downward, and invade important blood vessels and nerves on both sides of the skull, but the most common way of growth is to develop upward and compress the optic cross and optic nerve, causing vision loss and visual field defects.
Patients often complain of vision loss, not being able to see both sides, and always hitting the door. If it is accompanied by growth in other directions, it is called invasive pituitary adenoma, which is significantly more difficult to treat and difficult to remove at once.