Pituitary adenoma

Pituitary adenoma is the most common brain tumor, more specifically, of the chiasmatic-sellar localization, and, according to various sources, accounts for 6.7 to 18% of all brain tumors.

The source of tumors of this type are cells of the anterior pituitary gland.

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Symptoms pituitary adenomas

The main symptoms of pituitary adenoma are:

1. endocrinological disorders caused by increased (less often decreased) secretion of hormones;
2. visual disturbances caused by compression of the chiasm (decreased visual acuity, changes in visual fields, most often the development of bitemporal hemianopsia; formation of primary atrophy of the optic nerves, dysfunction of the II, III, IV, VI pairs of cranial nerves);
3. changes in the sella turcica (increase in size, deformation, destruction, etc.);
4. the formation of hypertensive syndrome (with large tumor sizes) and disruption of cerebrospinal fluid circulation with the development of hydrocephalus.

Pituitary adenoma, the symptoms of which are the formation of gigantism (in children and adolescents) or acromegaly (in adults), is characterized by increased secretion of somatotropic hormone. Acidophilic adenoma is characterized by the development of splanchnomegaly (usually 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).

Basophilic adenoma of the pituitary gland is characterized by increased secretion of adrenocorticosteroid hormone. The main clinical manifestations of hypercorticism are obesity of the upper body, face, the presence of pink-purple striae, acne, hirsutism, arterial hypertension, systemic osteoporosis, menstrual irregularities and sexual dysfunction.

Prolactinomas are characterized by the presence of galactorrhea syndrome, amenorrhea (in women), sometimes hirsutism, acne (arise as a result of activation of the adrenal glands).

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Forms

According to the histological type, pituitary adenoma is divided into the following variants: acidophilic (somatotropinoma, 13-15%); basophilic (corticotropinoma, 8-15%); prolactinoma (25-28%); thyrotropinoma (1%); gonadotropinoma (7-9%); mixed forms (adenomas that secrete more than one hormone, 3-5%), as well as endocrinologically inactive adenomas (oncocytoma, adenocarcinoma, non-oncocytic adenoma, etc.).

According to the nature of growth, the following are distinguished: infrasellar, suprasellar, parasellar, antessellar, retrosellar and combined variants of pituitary adenomas.

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Diagnostics pituitary adenomas

Pituitary adenoma is diagnosed using endocrinologist consultations and the results of determining the level of pituitary hormones in the blood. An ophthalmologist consultation, MRI or CT of the brain are mandatory. Targeted craniography of the sella turcica has lost its key diagnostic value.

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Treatment pituitary adenomas

Pituitary adenoma, the treatment of which includes hormone therapy (drugs that reduce the secretion of a particular hormone), radiotherapy and surgical methods often has a favorable prognosis. Absolute indications for surgical intervention to remove a pituitary adenoma are: progressive decrease in visual acuity, narrowing of the visual fields due to compression of the chiasm and optic nerves, impaired motor innervation of the orbital muscles, the formation of occlusive hydrocephalus and increased intracranial pressure, hemorrhage into the tumor, nasal liquorrhea.

Removal of tumors of the chiasmal-sellar region is performed through three most frequently used approaches: transcranial subfrontal (with pronounced parasellar and supraretroantesellar growth), transnasal transsphenoidal (used in most cases) and sublabial transsphenoidal).

Radiation therapy in the treatment of pituitary adenomas is used in combination with surgical treatment of adenomas or in the presence of pronounced contraindications to the latter. The most radiosensitive is the pituitary adenoma - somatotropinoma. The total dose of the course of irradiation is 45-50 Gy.