I. Epidemiological overview
1.The incidence of the disease at home and abroad At present, China lacks epidemiological survey data of pituitary adenoma. According to the American epidemiological survey, the incidence of pituitary adenoma is 7.5-15 per 100,000. The incidence of pituitary adenoma during autopsy of normal deceased patients varies, ranging from 9% to 65%. A group of foreign studies showed that the detection rate of pituitary adenoma was 16% in a random sample of 100 normal people who underwent MRI of the saddle area, indicating that the detection rate of pituitary adenoma is very high, but most patients do not show clinical symptoms. With the continuous improvement of pituitary tumor detection level and the improvement of doctors’ treatment technology, the incidence rate of pituitary tumor and detected patients have a tendency to increase year by year.
2.Citizen’s awareness level of the disease The main symptoms of pituitary tumor in the early and middle stages are endocrine changes and affected vision. However, even the most characteristic manifestations of gigantism and acromegaly, which clearly point to pituitary tumor disease, are difficult to be recognized in the general population. Even in some primary care hospitals, it is difficult for a physician to realize that hypertension, hyperpigmentation, and centripetal obesity should be associated with ACTH tumors of the pituitary gland. What is rapidly increasing is the detection of large pituitary tumors in the elderly due to vision loss, which citizens and even physicians rarely seem to associate with a pituitary tumor compressing the optic nerve until it is detected. So citizens’ awareness of this disease is extremely low and lags behind other diseases.
3.The effective control status of the disease at home and abroad has no means that can be applied clinically for the prevention of pituitary tumor at home and abroad. However, early detection of pituitary tumor will bring great benefits to the future treatment. Regarding the treatment of pituitary tumors, the treatment plan is mainly determined by the size of the tumor, whether it secretes hormones and the patient’s complications. Treatment of pituitary tumors is a multidisciplinary and comprehensive treatment process. The departments involved in pituitary tumor treatment are mainly endocrinology, neurosurgery, radiotherapy, ophthalmology, and diagnostic imaging. From retrospective clinical data in China and abroad, it can be seen that a multidisciplinary collaborative pituitary tumor treatment center is much more effective in improving the treatment of pituitary tumor patients than a purely specialized treatment center. Therefore, it is recommended that patients with pituitary tumors should be seen at medical centers with comprehensive treatment for pituitary tumors. Postoperative follow-up and follow-up treatment of pituitary tumors is also a control aspect that needs attention.
4. Adverse effects of the disease (on the individual, family, and society) Early pituitary tumors affect patients in extremely different ways.
Non-functioning adenomas do not produce any symptoms for patients in the early stages. However, secretory pituitary tumors can cause great harm to patients in the early stages.
1. Prolactin-secreting pituitary tumors manifest as amenorrhea, lactation, and infertility. In men, the main manifestations of pituitary tumors are reduced male sexual function, such as decreased libido, impotence and infertility.
2. Growth hormone-secreting pituitary tumors. The main manifestations are gigantism (adolescent patients), facial changes, coarse hands and feet, excessive sweating, osteoarthrosis, carpal tunnel syndrome, swelling of the soft tissues and joints of the fingers (toes) of the hands and feet. Severe diabetes, hypertrophic heart disease, and tumors of the thyroid and colon, etc.
3.Adrenocorticotropic hormone (ACTH) secretion type pituitary tumor. The main manifestations are centripetal obesity, full-moon face, acne, hirsutism, and purple lines (purple-red skin lines on the body). Increased blood pressure, low blood potassium and diabetes mellitus. Often combined with mental illness.
4. Thyrotropic hormone (TSH) secreting pituitary tumor. The main symptoms of hypermetabolism are fever, excessive sweating, weight loss, panic attacks and atrial fibrillation.
5. There are also FSH and LH pituitary tumors. The main clinical manifestations are menstrual disorders and infertility in women and male hypogonadism and infertility in men. Hormone-secreting tumors can occur alone or be mixed tumors with increased secretion of two or more hormones, and the clinical manifestations also have corresponding mixed symptoms.
If the tumor invades the cavernous sinus of the neurovascular plexus around the pituitary gland, it will show symptoms of nerve compression such as ptosis, pupil enlargement and other clinical manifestations.
In addition, sudden pituitary stroke can occur in any volume of tumor. During the growth of tumor, due to poor vascular supply or abnormal growth of tumor blood vessels, tumor hemorrhage and necrosis of tumor tissues will occur under certain inducements. In case of complete hemorrhage and necrosis of tumor, sudden increase of tumor volume and compression of cavernous sinus will result in severe headache, nausea and vomiting or even blindness, hemiparesis, coma and death, requiring emergency surgical treatment. Incomplete or partial pituitary stroke of pituitary tumor can be mild headache, nausea and vomiting with general discomfort, which does not need special treatment, and the patient’s symptoms will be relieved by themselves within a few weeks, and the clinical symptoms of certain hormone-secreting tumors are reduced.
Risk management of the disease
(I) Main risk factors
Family history of the disease: There is no evidence that pituitary tumors have a genetic component, although some studies have shown that pituitary tumors are also associated with some fixed gene mutations. The pituitary tumor transform inggene (PTTG), a proto-oncogene, was found to be a strong cellular transform ing gene that plays an important role in the transformation of pituitary cells and the formation and growth of pituitary adenomas.
2.Disease genomics: In the study of genome sequence, there is no definite conclusion on pituitary tumor yet. The pituitary tumor transform inggene (PTTG) is a proto-oncogene. It was found that PTTG is a strong cell transform ing gene, which plays an important role in the transformation of pituitary cells and the formation and growth of pituitary adenoma.
3, bad behavioral habits: there is no literature at home and abroad to show what triggers the development of pituitary tumor. Even stroke of pituitary tumor is different from cerebrovascular stroke in that there is no clear causative factor, but untreated pituitary tumor is a clear causative factor of pituitary stroke.
4.Environmental or social factors: In recent years, domestic for scholars have done a lot of convincing exploration on the basis of environmental pollution and social management disorder and other situations that may induce the disease, and the degree of harm will be confirmed in the long-term epidemiological study.
5.Related primary diseases: pituitary tumors can be classified according to the size of the tumor and the different functions of hormone secretion. According to the size of tumor, pituitary tumor is divided into pituitary microadenoma (tumor diameter less than 1cm) and pituitary adenoma (tumor diameter greater than or equal to 1cm and less than 2cm), pituitary macroadenoma (tumor diameter greater than or equal to 2cm and less than or equal to 4cm), and pituitary giant adenoma (tumor diameter greater than 4cm). According to the different hormone secretion, they can be divided into hormone-secreting pituitary tumors and non-functioning adenomas. 1 Prolactin-secreting pituitary tumors 2 Growth hormone-secreting pituitary tumors. 3 ACTH-secreting pituitary tumors. 4 TSH-secreting pituitary tumors. 5 Other FSH and LH-secreting pituitary tumors.
(B) Risk assessment
1. Purpose of assessment.
To help individuals recognize disease risk factors and develop individualized health management plans and interventions. The most important part of risk assessment is health education and early detection of lesions; and reasonable and orderly screening is the most important means to detect lesions and protect health. Physical examination can be based on the existing items and procedures of physical examination in each unit in the country, with the first emphasis on the most common and most likely to rapidly affect the health and important functions of citizens. The following is recommended here.
Endocrine examination is relatively simple. Pituitary-related endocrine examination and pituitary MRI should be done in all cases where the following symptoms are present
(1) Prolactin-secreting pituitary tumor. Most of them are female patients, mainly manifesting amenorrhea, lactation and infertility. Male patients mainly present with male hypogonadism, such as decreased libido, impotence and infertility.
(2) Growth hormone-secreting pituitary tumors. The main manifestations are gigantism (occurring in adolescent patients with unclosed epiphyses), facial changes, enlarged hands and feet (increased shoe size), excessive sweating, osteoarthrosis, carpal tunnel syndrome, swelling of the soft tissues and joints of the fingers (toes) of the hands and feet, increased blood pressure, increased blood sugar, coronary heart disease, and tumors of the thyroid and colon, etc.
(3) Adrenocorticotropic hormone (ACTH)-secreting pituitary tumors. The main manifestations are centripetal obesity, full-moon face, acne, hirsutism, and purple lines (purplish-red skin lines on the body).
MRI of the pituitary gland should be performed in any patient with vision loss visual field defects.
All patients with pituitary tumors should have regular endocrine and pituitary MRI examinations regardless of the treatment used or not.
2.Grading of disease risk
(1) Mild disease risk: After the diagnosis of various pituitary tumors is established, there are no obvious clinical symptoms or the professional classification is 0-1; it is a potential risk type.
(2) High disease risk: The disease has become obvious, with clinical endocrine symptoms or visual field impairment, and professional grading of 1-2 or more.
(3) Disease risk: in a significant endocrine imbalance and affect the general condition, life and work disorders, cardiac hypertrophy loss, malignant hyperglycemia difficult to reconcile, malignant hypertension, hypokalemia, osteoporosis; vision is severely impaired, cavernous sinus compression appears cranial nerve palsy professional classification is classified as grade 3 or more.
(4) Confirmation of disease: The diagnosis of pituitary tumor is made mainly based on the corresponding clinical symptoms, signs, pituitary hormone testing, and imaging examinations. Pituitary hormones can be detected in many laboratories and even in primary hospitals.
In the diagnosis of pituitary tumors, imaging is a very important tool. Magnetic resonance imaging (MRI) of the saddle area has the highest detection rate of pituitary tumors. MRI of the saddle area with thin layers (one layer every 1 mm) of enhanced images, combined with dynamic contrast MRI, can also reveal pituitary microadenomas as small as 2-3 mm in diameter. Enhanced CT imaging of the saddle area is good for some of the pituitary macroadenomas, and can provide insight into the degree of destruction of the saddle base bone and the degree of pneumatization of the pterygoid sinus. The diagnosis of pituitary tumor is not difficult to determine by detailed clinical examination, physical examination, pituitary hormone measurement and imaging.
(iii) Risk factor intervention
1. Intervention principles (asymptomatic microadenoma).
(1) Adhere to the concept of priority, that is, to have a high degree of awareness of pituitary tumor disease; because pituitary tumor may not have any clinical symptoms in the non-onset stage and is completely “normal”; however, once the disease develops, it may deteriorate rapidly within a very short period of time, thus making the treatment effect worse, and the result of early treatment may be extremely different. There may be a great difference between the results of treatment and early treatment.
(2) Prevention oriented: Therefore, prevention oriented should be emphasized for asymptomatic pituitary tumors by insisting on complete checkups including endocrine and visual acuity and MRI once every 1-2 years; asymptomatic microscopic pituitary tumors can be left untreated, but the risk of rapid enlargement and pituitary stroke in these people should not be forgotten. Treating pituitary tumors at an early stage is definitely beneficial to improve the surgical outcome, reduce the risk of surgery, and buy more sufficient time and space for survival.
(3) Comprehensive intervention: This is the best way to treat pituitary tumors, which is predicated on the need to make an accurate diagnosis and timing of treatment.
The main intervention for pituitary tumors is long-term effective monitoring of asymptomatic microadenomas and early comprehensive treatment of symptomatic or larger ones.
Regarding the treatment of pituitary tumors, the treatment plan is determined by the size of the tumor, whether or not it secretes hormones, and the patient’s complications. Treatment of pituitary tumors is a multidisciplinary and comprehensive treatment process. The departments involved in pituitary tumor treatment are mainly endocrinology, neurosurgery, radiotherapy, ophthalmology, and diagnostic imaging. From retrospective clinical data in China and abroad, it can be seen that a multidisciplinary collaborative pituitary tumor treatment center is much more effective in improving the treatment of pituitary tumor patients than a purely specialized treatment center. Therefore, it is recommended that patients with pituitary tumors should be seen at medical centers with comprehensive treatment for pituitary tumors. The three main treatments for pituitary tumors include surgery, medications and radiation therapy. It is because no single method can achieve a complete cure for every pituitary tumor, so each treatment method has its own advantages and disadvantages and should be individualized according to the size of the patient’s pituitary tumor, hormone secretion, complications and co-morbidities, the patient’s age, whether the patient has fertility requirements and the patient’s financial situation.
As for radiotherapy, since pituitary tumors are adenomas and are inherently less sensitive to radiotherapy, nearly 70-80% of patients experience hypopituitarism after radiotherapy, which reduces the quality of life of patients, so radiotherapy is only suitable for patients with surgical residuals, those who cannot tolerate surgery, those who are not sensitive to drugs, and those with co-morbidities that cannot be treated with surgery or drugs.
Drug therapy In recent years, with the continuous improvement of drug development, drug therapy for hormone-secreting pituitary tumors has made great progress.
For pituitary prolactin-secreting tumors, it is now believed that more than 90% of patients (both microadenomas and macroadenomas) can be treated with dopamine agonists (short-acting agents bromocriptine, long-acting agents cabergoline) to control PRL levels and reduce the size of the tumor. Surgery is an option only for patients with prolactinomas who are allergic or drug intolerant to this class of drugs, who have acute symptoms due to tumor compression requiring emergency surgical decompression, or for patients who do not wish to undergo surgical treatment. During treatment with bromocriptine, the dose of bromocriptine should be gradually increased until the serum PRL level drops to normal level and then the dose is adjusted for long-term maintenance treatment. For patients with fertility requirements, bromocriptine should be discontinued after pregnancy. The vision should be reviewed regularly during pregnancy until bromocriptine treatment is resumed after delivery. For patients who experience miscarriage or stillbirth when bromocriptine is discontinued after pregnancy, the drug should be maintained until the dose of bromocriptine is adjusted after delivery. It has been clinically proven that no significant malformations or mental retardation have been observed in children born to pregnant women while taking bromocriptine.
For growth hormone-secreting pituitary tumors, the major advance in the last 20 years has been the use of growth inhibitory analogs. The clinical application of this drug has led to a significant increase in the cure rate of GH-secreting tumors. In recent years, long-acting preparations of growth inhibitor analogs such as long-acting octreotide and somatuline have been used in the clinic, which has led to a significant improvement in patient compliance. The preoperative application of these drugs can rapidly reduce the patient’s serum GH level, alleviate the patient’s symptoms, reduce the size of the tumor, and create good preoperative conditions for the complete removal of the tumor. Additional indications for the use of growth hormone analogs in GH-secreting tumors include: postoperative residual patients, and transitional treatment of patients whose GH has not been reduced to normal after radiotherapy. The application of growth hormone analogs provides the opportunity to prepare treatment before surgery for those patients who are unable to tolerate anesthesia due to concomitant heart failure, respiratory sleep apnea, poorly controlled hyperglycemia, and hypertension. In foreign countries, many patients who do not want to undergo surgical treatment have also achieved satisfactory therapeutic results with long-term application of growth inhibitor therapy for tumor control because they do not have to worry about medical costs. Growth inhibitor analogs for thyrotropin-secreting tumors have also achieved satisfactory therapeutic results. After application of drug therapy for GH-secreting pituitary tumors, it is now accepted that reduction of GH levels to less than 1ng/dl (GH value after glucose administration) and insulin-like growth factor (IGF-1) to the level of age-matched normal individuals in patients with GH-secreting tumors is the goal of biochemical cure. Patients with growth hormone-secreting tumors, regardless of the treatment they receive, should achieve several therapeutic goals: elimination of the tumor, reduction of tumor recurrence, GH attainment, relief of clinical symptoms, preservation of pituitary function as much as possible, improvement of the patient’s quality of life, and prolongation of the patient’s life expectancy.
Surgery is divided into open surgery and transnasal butterfly surgery. The risk of transsphenoidal surgery and the protection of optic nerve and pituitary function is much higher than that of open surgery. The risk of transsphenoidal surgery is much higher than that of open surgery.
(4) Long-term adherence: All patients treated for pituitary tumors should be followed up for life. The anterior pituitary function should be reviewed regularly (every 3-6 months) before and after surgery, and the MRI of the saddle area should be reviewed when necessary to monitor the recurrence and growth of the tumor. The level of anterior pituitary hormone secretion varies with age, so the pituitary hormone measurement should be done annually for one year after surgery, according to the patient’s specific condition, to replace the already low pituitary hormone according to the situation. Especially in patients with hypoadrenocorticism, the dose of prednisone (usually 2.5-7.5 mg/d for replacement therapy) should be increased to 3-5 times the replacement therapy dose in stressful situations (fever, exertion, illness, etc.) to prevent pituitary crisis. The replacement dose of other hormones is usually 50-150ug/day of thyroid hormone (L-T4), and it is safer to start replacement therapy with normal adrenocortical function. As for sex hormone replacement therapy, in patients with prolactinoma, it is not advocated while controlling prolactin levels medically because the tumor is sex hormone-dependent. In patients with other causes of hypopituitarism, when supplementing male hormones, the level of prostate antigen (PSA) in the blood should be monitored so that it is safer to maintain it at a low level. Growth hormone deficiency following surgery or radiation therapy for pituitary tumors can manifest as growth retardation in children, and GH deficiency in adults can cause corresponding clinical symptoms (see Clinical Manifestations of Pituitary Tumors). Pediatric patients can be treated with GH growth-promoting therapy when it is confirmed that the tumor has not recurred. In adult GH deficient patients, GH replacement therapy is also possible if they are financially available and do not have a pre-existing tumor or a clear family history of other tumors. There has been clinical experience with GH replacement therapy for adults for more than 10 years abroad, while China is only beginning to make a start in the treatment of GH deficiency in adults. As the price of GH preparation decreases, more patients with adult GH deficiency will benefit from it.
2.Graded interventions
Health education (what is health, disease, and its hazards) Clinical manifestations of pituitary tumor: various endocrine cells in the pituitary gland can produce corresponding endocrine cell adenomas, causing endocrine function disorders. In the early stage of microadenoma, signs of endocrine hyperfunction can appear. As the adenoma grows and develops, it can compress and erode the pituitary tissue and its pituitary and peripituitary structures, resulting in symptoms of decreased endocrine function, visual impairment and other cranial nerve and brain symptoms.
Pituitary tumors and hypogonadism: Hypogonadism refers to impotence and decreased libido, which is one of the clinical manifestations of early onset pituitary adenoma.
The main reasons for low sexual function caused by pituitary tumors are.
1, pituitary tumor on the normal pituitary tissue compression and radiation therapy damage caused by the pituitary gland function is low, affecting the human body hypothalamus – pituitary – gonadal axis, so that gonadotropin secretion is insufficient, further leading to hypogonadism.
2. Prolactinomatous pituitary microadenoma, which manifests as menopause, lactation and infertility in women and impotence and hypogonadism in men, is related to hyperprolactinemia that inhibits gonadotropin release, reduces pituitary responsiveness and decreases testosterone production, in which case testosterone supplementation alone is not effective. ug/L)
3. Thyrotropin adenoma due to low thyroid function and slow systemic metabolism, so that the metabolism of estrogen and androgen in the body decreases with the lack of thyroxine.
4. Obesity caused by patients with adrenocorticotropic hormone type and growth hormone type pituitary adenoma is also one of the causes of low sexual function. Pituitary tumors and infertility. Lactation . Due to the influence of high prolactin secretion and the reduction of estrogen, female patients often show significantly reduced menstrual flow, lactation (wetting of underwear in contact with nipples), followed by amenorrhea and infertility, which greatly affects physical and mental health and family life. Patients are guided to the correct treatment.
Pituitary tumors and headaches.
About 2/3 of patients have headaches in the early stages, with pain mainly located behind the orbits, in the forehead and near the temples bilaterally, with milder, intermittent attacks. Since pituitary tumor originates in the saddle of the butterfly at the base of the skull, the saddle is surrounded by dense bone and only the upper part of the saddle is covered with a tough saddle septum, the direct stimulation or growth of the tumor causes the headache due to the increase of intra-saddle pressure. Patients often feel that after a sudden severe headache, the pain is obviously reduced or relieved, but if no treatment is given, the pain will appear again as the tumor grows.
Pituitary tumors and vision loss . Pituitary tumors in the saddle can break through the saddle base and grow downward, and invade important blood vessels and nerves in the skull on both sides, but the most common way of growth is to develop up the saddle and compress the optic cross and optic nerve, which causes 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 visual field impairment occurs, surgery is needed as soon as possible to release the compression on the optic nerve and save vision. 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.
Pituitary adenomas and changes in the face, limbs and body shape.
Growth hormone pituitary adenoma, due to its excessive secretion of growth hormone, leads to excessive growth of limbs, muscles and internal organs, manifesting as gigantism before the epiphysis fuses at puberty, and in adults, manifesting as large hands and feet (gradually increasing shoe size), wide skull and face, high cheekbones, enlarged nose, thickened lips, loose, coarse and dark skin, increased hair, and hoarseness, sleep snoring and sleep apnea syndrome; and In adrenocorticotropic adenoma, due to abnormal fat metabolism and distribution, fat accumulates in the chest, abdomen and buttocks, while the extremities are relatively thin and “centripetal obesity”, the face is full-moon shaped, the weight increases significantly, and the subcutaneous blood vessels of the extremities are exposed and have purple lines. These two types of pituitary adenomas seriously affect the external image of a person and should be treated aggressively. Growth hormone-type pituitary adenomas usually have significant results within a few days after surgery, and patients feel that their limbs and faces have shrunk, their skin has become delicate and smooth, and their sleep quality has been significantly relieved.
Pituitary tumors with other nerve and brain damage.
If the tumor develops posteriorly and superiorly pressing the edge of pituitary stalk and hypothalamus may cause uveitis and hypothalamic dysfunction, and involving the third ventricle, interventricular foramen and aqueduct may cause increased intracranial pressure. Anterior extension to the frontal lobe can cause psychiatric symptoms, epilepsy, and olfactory disturbance. Lateral invasion of the cavernous sinus may cause II, IV, V, VI cranial nerve palsy, and protrusion into the middle cranial fossa may cause frontal lobe epilepsy. If it grows backward into the interpeduncular pool and slope to compress the brainstem, crossed paralysis and coma may occur. Downward protrusion into the pterygoid sinus, nasal cavity and nasopharynx may result in epistaxis and cerebrospinal fluid leakage. Complicated intracranial infection.
With the popularization of pituitary tumor screening and the emergence of an aging population, pituitary disease will further increase for quite some time in the future, and the danger to society will subsequently increase. Therefore, it has long been the urgent wish and important subject of medical research to strengthen basic and clinical research on pituitary tumor prevention and treatment, especially how to intervene by effective means after endocrine injury or damage to the optic nerve and other cranial nerves, so as to promote the restoration of its inherent function and cure the tumor as soon as possible and with limited compensatory capacity.
(1) Identification of non-functional microadenomas in high-risk individuals
Even the absence of any symptoms implies the arrival of a suboptimal stage. If there are clear endocrine alterations, they are manifested as amenorrhea, lactation and infertility. In male patients, the main manifestations are male hypogonadism, such as decreased libido, impotence and infertility. Gigantism (in adolescent patients), facial changes, coarse hands and feet, excessive sweating, osteoarthropathy, carpal tunnel syndrome, and swelling of the soft tissues and joints of the fingers (toes) of the hands and feet. Severe diabetes mellitus, hypertrophic heart disease, and tumors of the thyroid and colon, etc. Manifestation of centripetal obesity, full-moon face, acne, hirsutism, purple lines (purplish skin lines on the body). Increased blood pressure, low blood potassium and diabetes mellitus. Often combined with mental illness. Or the presence of visual field damage and other cranial nerve damage can be classified as a high-risk individual and requires increased vigilance.
(2) Effective management of the primary disease
①Disease diagnosis: The diagnosis of pituitary tumor is mainly based on the corresponding clinical symptoms, signs, pituitary hormone tests and imaging examinations. Pituitary hormones can be detected in many laboratories and even primary hospitals. However, in the process of clinical diagnosis and treatment, they often rely too much on laboratory tests and ignore the special requirements of the secretion rhythm of pituitary hormones on the time of blood collection, which makes the hormone measurement results of many patients impossible to judge.
Among the hormones secreted by the pituitary gland, GH, ACTH and PRL have obvious circadian rhythms and are all stress hormones. The clinical time for GH and ACTH should be 8AM (fasting), and the blood should be taken at rest for more than half an hour in a quiet state before taking blood. The measurement of blood PRL should be taken between 10AM and 2PM, and the measured PRL results should be valley values, so that the measured values can reflect the serum PRL levels of the patient under non-stressful conditions.
Imaging is a very important tool in the diagnosis of pituitary tumors. Among them, magnetic resonance imaging (MRI) of the saddle area has the highest detection rate of pituitary tumors. MRI of the saddle area with thin layers (one layer every 1 mm) of enhanced images, combined with dynamic contrast MRI, can also reveal pituitary microadenomas as small as 2-3 mm in diameter. Enhanced CT imaging of the saddle area is good for some of the pituitary macroadenomas, and can provide insight into the degree of destruction of the saddle base bone and the degree of pneumatization of the pterygoid sinus.
The diagnosis of pituitary tumor is not difficult to determine through detailed clinical interview, physical examination, pituitary hormone measurements, and imaging tests.
After the diagnosis of the primary disease, those who are completely healthy will continue to be maintained; those who are found to have asymptomatic non-functional adenomas both in the early stage of the disease will be included in the primary prevention of the tertiary prevention of pituitary tumor disease and will be corrected in time; those who have obvious endocrine symptoms of the disease, or those who have impaired visual field and have certain critical signs will be included in the secondary or even directly into the tertiary prevention procedure.
② Management of the disease outside the hospital if there are clear endocrine changes, manifested as amenorrhea, lactation, and infertility. Male patients mainly present with low male sexual function, such as decreased libido, impotence and infertility. Gigantism (in adolescent patients), facial changes, coarse hands and feet, excessive sweating, osteoarthropathy, carpal tunnel syndrome, and swelling of the soft tissues and joints of the fingers (toes) of the hands and feet. Severe diabetes mellitus, hypertrophic heart disease, and tumors of the thyroid and colon, etc. Manifestation of centripetal obesity, full-moon face, acne, hirsutism, purple lines (purplish-red skin lines on the body). Increased blood pressure, low blood potassium and diabetes. Or the presence of visual field damage and other cranial nerve damage should prompt a hospital visit. If the original pituitary tumor develops severe headache, vision loss, diplopia or even hemiplegic coma, it needs to be treated immediately at the emergency hospital.
(3) Major complications and warning
(1) Clinical manifestations caused by increased hormone secretion.
a. Prolactin-secreting pituitary tumor. Most female patients mainly present with amenorrhea, lactation and infertility. Male patients mainly present with male hypogonadism, such as decreased libido, impotence and infertility.
b. Growth hormone-secreting pituitary tumors. The main manifestations are gigantism (occurring in adolescent patients with unclosed epiphyses), facial changes, enlarged hands and feet (increased shoe size), excessive sweating, bone and joint lesions, carpal tunnel syndrome, swelling of the soft tissues and joints of the fingers (toes) of the hands and feet, increased blood pressure, increased blood sugar, coronary heart disease, and tumors of the thyroid gland and colon, etc.
c. Adrenocorticotropic hormone (ACTH) secreting pituitary tumor. The main manifestations are centripetal obesity, full-moon face, acne, hirsutism, and purple lines (purple-red skin lines on the body).
d. Thyrotropic hormone (TSH) secreting pituitary tumor. The main manifestations are symptoms of hypermetabolism fear of heat, excessive sweating, weight loss, heartburn atrial fibrillation, etc.
The clinical manifestations of pituitary tumors that reduce the secretion of corresponding hormones due to compression of surrounding cells and tissues: for example, hypoadrenocorticism can be manifested as decreased appetite, weakness, emaciation, hypotension, hypoglycemia, easy to catch a cold, etc.; hypothyroidism can be manifested as fear of cold, decreased appetite, rough skin, hair loss, constipation, etc.; in children, it can be manifested as dementia, growth retardation, etc.; hypogonadism can be manifested as Hypogonadism can be manifested as infertility in men and women, decreased libido, menstrual disorders or even amenorrhea in women, impotence in men, etc. Clinical manifestations of reduced secretion of growth hormone can be manifested as short stature in children and concentration of body fat in the abdomen, muscle relaxation and atrophy, aging, decreased self-awareness, osteoporosis, decreased resistance, and low sexual function in adults.
If the tumor invades the cavernous sinus of the neurovascular plexus around the pituitary gland, it will show symptoms of nerve compression such as ptosis, pupil enlargement and so on.
④Pituitary stroke: due to poor vascular supply or abnormal growth of tumor blood vessels during the growth process, tumor bleeding and necrosis of tumor tissues will occur under certain inducements. If the tumor is completely hemorrhagic and necrotic, the tumor envelope will rupture, there will be severe headache, nausea and vomiting or even blindness and coma, which needs emergency surgical treatment. Most strokes of pituitary tumors are incomplete or partial pituitary strokes, which can be mild headache, nausea and vomiting with general discomfort and do not require emergency surgery.
Evaluation of health management effect
1. My knowledge of pituitary tumor
(1) Understand the three main risk factors of pituitary tumor: endocrine changes, compression of surrounding tissues and pituitary stroke.
(2) Have a clear understanding of the risk factors for asymptomatic pituitary tumors.
(3) Confidence in the treatment of pituitary tumors.
2. Personal implementation of health management plan
(1) To inform people of the serious risks of pituitary tumors so that they can pay sufficient attention to them and take active preventive measures.
(2) Informing people of the main manifestations of pituitary tumor development and knowing how to grade the risk.
(3) What to do when a pituitary tumor is detected. For example, when is the best time to go to the doctor after the onset of the disease? What kind of hospital should be the first choice? How to cooperate with health care professionals for treatment and rehabilitation, etc.
3.The degree of improvement of pituitary tumor risk factors
(1) Citizens’ awareness of pituitary tumors has improved.
(2) Control of risk factors and treatment of risk factors after diagnosis of pituitary tumor
(3) Effective interventions were taken in conjunction with their own health conditions.