1.What kind of tumor is pituitary adenoma?
Pituitary adenoma is a benign intracranial tumor, the incidence of which is second only to glioma and meningioma, accounting for about 10-15% of intracranial tumors.
2. What are the clinical manifestations of pituitary prolactin adenoma?
Prolactin adenoma is clinically significantly higher in women than in men, and the peak incidence in both sexes is between 20 and 40 years old, while in women there are two peak incidences, namely between 20 and 30 years old and between 60 and 70 years old, and in men it increases with age. Fertile women tend to show oligomenorrhea or amenorrhea, infertility and overflow of breast milk. In men and menopausal women, the tumor develops suprasellarly for a long time and compresses the optic cross-optic nerve, causing visual field vision impairment. In severe cases, weakness, drowsiness, headache, hypogonadism, mental abnormalities v8w, hair loss, increased bone density, obesity, etc.
3.How to diagnose pituitary prolactin adenoma?
The current diagnosis of pituitary prolactin adenoma is based on the following three aspects.
v1w clinical diagnosis is mainly based on the following clinical manifestations.
(i) Amenorrhea, lactation and sexual dysfunction due to hyperprolactinemia.
â‘¡ headache and visual field impairment due to the occupational effect of the tumor;
â‘¢Prolonged deficiency of estrogen can lead to osteoporosis and infertility. In male patients, the main manifestations are loss of libido, impotence, beard thinning, breast enlargement, lactation, infertility, atrophy of reproductive organs in severe cases, and reduction of sperm count
v2w Imaging diagnosis mainly relies on cranial CT and MRI. CT and MRI scans can detect abnormal density and signal shadows in the pituitary and saddle areas, and imaging diagnosis is also the main diagnostic method at present.
The normal maximum value of PRL is 30ug/L in women and 20ug/L in men. if PRL>100ug/L is due to pituitary tumor, >300ug/L is more certain for PRL adenoma.
4.What treatment options are available for pituitary prolactin adenoma?
The current treatment options for pituitary prolactin adenoma include drug therapy, microsurgical resection therapy, and stereotactic radiosurgery therapy.
The representative drugs of v1w drug treatment are bromocriptine, carmacrolimus, norgonine and so on. The most commonly used drug in clinical practice is bromocriptine, whose mechanism is to selectively agonize D-2-R on the membrane of lactogenic cells, thus inhibiting the expression of lactogenic mRNA gene and lactogenic cell metabolism, resulting in the reduction of lactogenic synthesis and secretion, as well as the curling of endoplasmic reticulum and Golgi apparatus, and inhibiting cell reproduction, resulting in the crumpling of tumor volume.
The possible side effects of bromelain include nausea, postural vertigo, fatigue, nasal congestion, etc. The main disadvantage of drug therapy is the long duration of medication, some patients need to take the drug for life, and the serum prolactin level may increase or the tumor may expand again after stopping the drug. In addition, it can also lead to fibrosis of part of the tumor and increase the difficulty of surgical resection.
The majority of tumors can be treated by surgical resection. v3w microsurgical resection is the main treatment method.
The gamma knife system belongs to the stereotactic radiosurgery, according to the principle of stereotactic, using 201 tiny radiation source drill 60 radiated yag rays to selectively determine the target of normal or diseased tissues in the skull, using a large dose of narrow beam radiation to precisely focus on the target, so as to produce focal destruction and achieve the purpose of treating intracranial diseases. .
5.What are the ways of surgical treatment?
Surgical treatment is divided into two ways: transfrontal subcranial approach and single nostril pterygoid sinus approach.
The transfrontal subcranial approach can clearly reveal the suprasellar structures, and its indications are invasive tumors that develop on the septum and infiltrate the skull base and cavernous sinus. The single nostril pterygoid approach has the advantages of short route, little damage, easy operation and fast postoperative recovery, and its indications are:
(1) The tumor is confined to the saddle or protrudes into the pterygoid sinus;
(2) anterior visual crossover;
(3) Combined with empty saddle or cerebrospinal fluid nasal leakage;
(4) Cystic pituitary adenoma or pituitary adenoma stroke;
(5) Tumor extending up the saddle in a columnar pattern;
(6) Tumor infiltrating to the slope;
(7)Those who are too old and weak to tolerate craniotomy.
6.What kind of surgical approach has been carried out in our hospital to treat pituitary adenoma?
Transcranial cranial approach is a traditional surgical approach, which has been carried out ten years ago, but the single nostril pterygoid approach is an emerging surgical approach in recent years, which has the advantages of short path, small injury, easy operation, fast recovery and no impact on appearance. hundred successful cases. It has been well received by patients and has been widely accepted by them, and is currently the main surgical approach we use. Especially in 2010, our department newly introduced the special neurosurgery bed and neurosurgery high-definition microscope, which is a very high safety guarantee for this surgery.
7.What are the precautions for pituitary adenoma patients after surgery?
Because pituitary adenoma is a benign tumor, most patients can be cured by surgery. Patients treated by single-nostril pterygoid sinus surgery can be discharged from hospital after five to seven days of bed rest. If there is a small amount of residual can be supplemented with gamma knife radiation therapy can also achieve the purpose of cure.