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Pituitary adenoma
Last reviewed: 23.04.2024
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Adenoma of the pituitary gland is the most common brain tumor, and more specifically - chiasmally-sellar localization and amounts to 6.7 to 18% of all neoplasms of the brain according to various data.
The source of tumors of this type are cells of the anterior lobe of the pituitary gland.
Symptoms of the adenomas of the pituitary gland
The main symptoms of pituitary adenoma are as follows:
- endocrinological disorders due to increased (less often decreased) hormone secretion;
- visual disorders due to compression of the chiasma (decreased visual acuity, changes in visual fields, more often the development of bitemporal hemianopsia, the formation of primary atrophy of the optic nerves, dysfunction II, III, IV, VI pairs of cranial nerves);
- changes in the Turkish saddle (increase in size, its deformation, destruction, etc.);
- the formation of hypertensive syndrome (with a large tumor size) and the violation of liquor circulation with the development of hydrocephalus.
Adenoma of the pituitary gland whose symptoms are manifested by the formation of gigantism (in children and adolescents) or acromegaly (in adults) is characterized by an increase in the secretion of growth hormone. Acidophilic adenoma is characterized by the development of splanchnomegaly (more often cardiomegaly), arterial hypertension (25-35% of patients), diabetes mellitus (15-19% of patients), dysmenorrhea and amenorrhea in women (70-80% of cases), sexual disorders in men in the form of impaired spermatogenesis, testicular atrophy (30-45% of cases).
The basophilic adenoma of the pituitary gland is characterized by an increase in the secretion of adrenocorticotrophic hormone. The main clinical manifestations of hypercortisy are obesity of the upper body, face, the presence of pink and purple striae, acne, hirsutism, arterial hypertension, systemic osteoporosis, menstrual disorder and sexual dysfunction.
Prolactinomas are characterized by the presence of the syndrome of galactorrhea, amenorrhea (in women), sometimes hirsutism, acne (arise from the activation of the adrenal glands).
Forms
According to the histological type, the pituitary adenoma is divided into the following variants: acidophilic (somatotropinoma, 13-15%); basophilic (corticotrophinoma, 8-15%); prolactinoma (25-28%); tirotropinoma (1%); gonadotropinoma (7-9%); mixed forms (adenomas that secrete more than one hormone, 3-5%), as well as endocrinologically inactive adenomas (oncocytoma, adenocarcinoma, neoncoccitic adenoma, etc.).
By the nature of growth, there are: infrasonic, suprasellar, parasellar, antesellar, retrosellar and combined variants of pituitary adenomas.
Diagnostics of the adenomas of the pituitary gland
Pituitary adenoma is diagnosed with the help of endocrinologist consultations and the results of determining the level of pituitary hormones in the blood. Obligatory consultation of an ophthalmologist, an MRI or CT of the brain is mandatory. Aimed craniography of the region of the Turkish saddle has lost a key diagnostic value.
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Treatment of the adenomas of the pituitary gland
Adenoma of the pituitary gland whose treatment includes hormone therapy (drugs that reduce the secretion of a hormone), radiotherapy and surgical methods often have a favorable prognosis. Absolute indications for surgical intervention regarding the removal of pituitary adenoma are: progressive reduction in visual acuity, narrowing of the visual fields due to compression of the chiasma and optic nerves, impaired motor innervation of the orbital muscular apparatus, occlusive hydrocephalus formation and increased intracranial pressure, hemorrhage into the tumor, nasal liquorrhea.
Removal of tumors of the chiasmatic-selar region is made from the three most commonly used approaches: transcranial subfrontal (with pronounced parasellar and suproretroantesellar growth), transnasal transsphenoidal (used in most cases) and sublabial transsphenoidal).
Radiation therapy in the treatment of adenomas of the pituitary gland is used in combination with surgical treatment of adenomas or in the presence of severe contraindications to the latter. The most radio sensitive is the pituitary adenoma - somatotropinoma. The total dose of exchange exposure is 45-50 Gy.