1.Headache
Early 2/3 of patients have headache, mild, intermittent attacks.
2.Optical nerve dysfunction
The neurological symptoms caused by pituitary adenoma are directly related to the size of the tumor and its growth direction. Generally speaking, when non-functional adenoma is diagnosed, the size of the tumor is already large, and the tumor mostly grows towards the upper saddle and outside the saddle, so the clinical neurological symptoms are more obvious. When the pituitary tumor grows upward, it may press the saddle septum upward or break through the saddle septum and press the optic nerve cross and produce vision and visual field change.
3.Endocrine dysfunction
Each type of functional adenoma can secrete too much hormone and produce different symptoms of endocrine hyperactivity in early stage. Non-functional adenomas can compress and destroy the anterior pituitary cells, resulting in a decrease in hormone production and corresponding target organ hypofunction, resulting in clinical symptoms of hypoendocrine function. Functional adenomas may also produce hypopituitarism in the late stage of the disease.
4.Adjacent compression symptoms
It is caused by the growth of tumor outside the saddle and compression of adjacent structures. Most of the tumors are large in size, and the following symptoms account for about 5% of pituitary tumor patients.
(1) Lateral development: Compression or invasion of the cavernous sinus can produce disorders of the third, fourth and sixth cranial nerves and the first branch of the trigeminal nerve, among which the articulatory nerve is most often involved, causing ptosis and ocular movement disorders. If the tumor grows around the internal carotid artery, the lumen of this artery may be narrowed or occluded, resulting in hemiplegia and aphasia. If the tumor grows into the trigeminal nerve capsule, it may produce secondary trigeminal neuralgia. The growth into the middle cranial fossa may affect the temporal lobe, and there are hookback seizures with symptoms such as phantom smell, phantom taste, light hemiparesis and aphasia.
(2) Development to the anterior side: It may compress the frontal lobe and produce psychiatric symptoms, such as apathy, euphoria, acute mental retardation, amnesia, inability to take care of oneself, epilepsy, unilateral or bilateral olfactory disorder, etc.
(3) Posterior development: It may grow into the interpeduncular fossa, compressing the peduncle and the oculogyric nerve, causing oculogyric nerve paralysis on one side and light hemiparesis on the opposite side, i.e. Weber syndrome. It may even cause obstructive hydrocephalus by posteriorly compressing the aqueduct.
(4) Superior growth: Affecting the third ventricle, it may produce hypothalamic symptoms, such as excessive drinking, polyuria, drowsiness, psychiatric symptoms such as amnesia, imagination, hallucinations, disorientation, retardation, optic papillar edema, and coma.
(5) Downward growth: It may destroy the saddle base and grow into the pterygoid sinus and nasopharynx, producing recurrent small amount of nasal bleeding, nasal congestion and cerebrospinal fluid nasal leakage.
(6) Outward growth: It may grow into the internal capsule and basal ganglia, resulting in hemiplegia and sensory disorders.
The characteristic manifestations of each pituitary tumor.
1. Prolactin adenoma.
Prolactin increase and estrogen decrease can lead to amenorrhea, lactation and infertility; pituitary hypofunction can show weakness, drowsiness, hypogonadism, mental abnormalities, hair loss and obesity, etc. PRL>100ug/IL (normal, <20ug/L in men and <30ug/L in women).
2. Growth hormone adenoma.
Increased growth hormone can lead to acromegaly, gigantism; hypogonadism, amenorrhea, infertility; sleep apnea syndrome caused by sleep collapse on hypertrophic tongue and throat, etc. GH5-10ug/L, 90% higher than 10ug/L (normal 2-4ug/L).
3. Adrenocorticotropic adenoma.
Expression for Cushing’s syndrome, centripetal obesity, full moon face buffalo back, hypogonadism or sterility, etc., urinary free cortisol (UFC) >100ug that has diagnostic significance (normal 20-80ug/24).
4. Thyroid-stimulating hormone cell adenoma.
Due to increased TSH secretion T3 and T4 increase, manifesting as hyperthyroidism symptoms.
5. Gonadotropin cell adenoma.
Hypogonadism, amenorrhea, infertility, etc.
6, non-secretory cell adenoma.
Also known as suspicious cell tumor, early asymptomatic, when the tumor grows to compress the optic cross and pituitary tissue manifesting as headache, visual dysfunction and pituitary hypofunction (in the order of gonadal, thyroid, adrenal hypofunction or mixed symptoms body features.)
7. Pituitary adenocarcinoma.
Infiltrative growth with surrounding adjacent tissues, with distant metastasis, which behaves like functional pituitary adenoma.