Pituitary adenomas (pituitary tumors) originate mainly from the anterior pituitary gland (adenopituitary gland) Definition: Microadenomas: pituitary tumors <1 cm in diameter. Larger ones are considered to be macroadenomas. Approximately 50% of pituitary tumors are now <5mm at diagnosis, increasing the difficulty of finding them intraoperatively.
Clinical presentation: Symptoms due to endocrine dysfunction or occupying effects are usually the main complaint, and macroadenomas may cause headaches. Seizures are largely unrelated to pituitary adenomas. A few present with pituitary stroke. Very few aggressive tumors may present with cerebrospinal fluid nasal leakage.
Pituitary adenomas are usually classified as functional (or secretory) or nonfunctional (also called endocrine inactive, not secreting or secreting products such as gonadotropins that do not cause endocrinological symptoms).
Clinical features: visual impairment, depressed mental status, symptoms of cavernous sinus compression, headache, symptoms of hypothalamic involvement, acute hydrocephalus, etc.
Treatment: 1. oral bromocriptine for prolactinoma; PRL > 500 can be treated with oral bromocriptine (Parlodel).
2.Surgical treatment: including transsphenoidal pituitary adenomectomy (minimally invasive) and open pituitary adenomectomy.
3.Radiation therapy: It can usually normalize the serum cortisol level. It is useful for postoperative recurrence and for tumors that are difficult to reach surgically (e.g. cavernous sinus).