In the brain there is an endocrine gland, affecting the real exchange processes, growth and reproductive functions. It is called the pituitary gland and consists of two parts - neurohypophysis and adenohypophysis.
The weight of the pituitary gland in an adult is about half a gram. Adenohypophyseal functions are reduced to the production of hormonal substances for normal activity of testes, ovaries and thyroid glands, adrenals and lactation, as well as for full growth.
The adenohypophysis produces follicle-stimulating, luteinizing, thyrotropic, adrenocorticotropic hormone, prolactin and somatotropin.
Neurohypophysis is responsible for the production of oxytocin, controlling lactation and birth processes, and antidiuretic hormonal substance responsible for the water-salt balance.
Under the influence of unfavorable factors pituitary tissues begin to grow, which leads to the formation of a tumor - adenoma.
Concept of the disease
Pituitary adenoma is a tumor-like formation of benign nature that grows from the glandular tissues of the anterior pituitary lobe( adenohypophysis).
This video tells about the manifestation, diagnosis and treatment of pituitary adenoma:
Pituitary adenomas are found everywhere, regardless of geographic location and race, and tumors are equally common in patients of both sexes. In addition to corticotropin-secreting formation, which in the weaker sex is revealed four times more often.
According to the international classification of pathologies, pituitary adenoma has the code D35.2.
Causes of
The etiological features of pituitary adenomas are still being actively studied by medical scientists. It is difficult to say for sure what causes such formations, however, it is known that their development is promoted by factors like:
- Neuroinfectious pathologies such as brucellosis and tuberculosis, meningitis and neurosyphilis, cerebrospinal abscess and encephalitis, poliomyelitis or cerebral malaria, etc.;
- Adverse effects in intrauterine development such as drug abuse, exposure to toxic substances, ionizing radiation;
- Craniocerebral traumatic factors;
- In women, uncontrolled and prolonged use of oral contraceptives can also provoke tumor development;
- Sometimes pituitary formations are formed under the influence of excessive hypothalamic stimulation. Usually a similar etiological pattern occurs with hypothyroidism or hypogonadism, etc.;
- Unfavorable heredity can also contribute to the formation of such an education.
Classification of adenomas of the pituitary gland
Pituitary adenomas are divided into 2 major categories: tumors with hormonal activity and those without it. Hormonal active formations, found in 60% of cases, are able to produce hormones of the pituitary gland, the treatment of such formations is handled by endocrinologists.
Hormoneally inactive adenomas, occupying 40% of cases, are unable to produce hormonal substances, so patients with similar tumors are administered by neurologists.
Depending on the hormone produced, the pituitary adenomas are classified into:
- Gonadotropinomas;
- Somatotropinomas;
- Thyrotropinomas;
- Corticotropinomas;
- Prolactinomas, etc.
Approximately 15 tumors from a hundred have a mixed character, producing several hormonal substances. In addition, according to the size, the pituitary adenomas are giant( <10 cm), macroadenomas( 1-10 cm) and microadenomas( > 1 cm).
Adenomas are classified and in accordance with localization:
- Endosuprasellar - grows towards the top of the Turkish saddle;
- Endoinfrasellar - grows down;
- Intrasellar - does not leave the borders of the Turkish saddle;
- Endolateroselyarnaya - sprouts into the side of the Turkish saddle.
There are other forms of pituitary adenomas, which we will consider below.
Eosinophilic
Adenomas of this type are formed by their acidophilic adenocytes, differ in slow growth and do not tend to metastasize.
Such formations account for about 10-14% of all pituitary tumors.
Gigantism or acromegalia are typical for such formations. Most often, such formations are represented by somatotropic formations.
Most patients have headaches and visual disorders, rhinorrhea.
All patients with acromegaly have several characteristic features:
- Deformation changes and bony proliferation;
- Hypertrophic soft tissue changes;
- Violated real-exchange processes, etc.
Basophilic
Basophilic pituitary adenomas are detected in patients quite rarely. A characteristic manifestation of such education is exchange-endocrine disorders without visual disturbances.
Such tumors occupy about 8-14% of the total number of pituitary adenomas, representing corticotropic formations.
Basophilic pituitary tumors are detected more often in young patients who, against the background of pathology, begin to suffer from amenorrhea or dysmenorrhea, face and body obesity, and increased blood sugar.
Cystic
A similar adenoma is formed as a cavity filled with fluid in any part of the pituitary gland. It causes menstrual disorders, headaches, male sexual dysfunction, epilepsy and decreased sensitivity in the limbs, visual disturbances or increased blood pressure.
Endosellar
Endosellar pituitary adenoma is a benign growth of the brain within the Turkish saddle.
Endosuprasellar
The growth of such pituitary tumors is directed upward beyond the borders of the tissues of the Turkish saddle.
Symptoms in women, men and children
The clinical picture of the pituitary adenoma is characterized by the presence of neuro-ophthalmic manifestations, caused by compression of the formation on the structures of intracranial localization near the saddle. Hormonal active tumors are manifested by endocrine-exchange syndrome.
In general, all the symptoms are reduced to endocrine, neurological and ophthalmologic disorders. Inactive education can develop for several years without any manifestations, until they grow to large sizes. According to statistics, approximately 12% of patients have latent leaking microadenomas.
- Endocrine-exchange syndrome
In adults with somatotropinomas, acromegaly is noted, children have gigantism. In addition to skeletal changes, there is symptomatology such as obesity, diabetes, an increase in thyroid volume without its functional disorders, hypertension and greasiness of the skin, rashes like papillomas, nevi or warts.
Corticotropinoma is always accompanied by a disease of Itenko-Cushing, manifested by skin pigmentation, mental abnormalities, is prone to malignancy and metastasis. Prolactinoma is manifested in women and men in different ways.
For ladies characterized by infertility, no monthly, galactorrhea and other menstrual disorders, acne, seborrhea, anorgasmia. Men with prolactinoma are characterized by the presence of galactorrhea, gynecomastia, decreased sexual desire, erectile dysfunction and a complex of ophthalmic-neurological manifestations.
Gonadotropic tumors are manifested by hypogonadism and signs of an ophthalmic-neurologic syndrome. With thyrotropinoma of primary origin, the presence of hyperactive thyroid is typical; if it is secondary, hypothyroidism takes place.
- Ophthalmic-neurological syndrome
The severity of such a complex of symptoms is determined by the direction of tumor growth. Most often, these manifestations are associated with:
- Diplomacy;
- Changing the visual fields;
- Headaches;
- Oculomotor disorders, etc.
With the lateral nature of tumor growth, the adenoma begins to squeeze the nervous branches, which leads to the appearance of double vision and oculomotor disorders.
When formation compresses the optic nerves located under the pituitary gland, the limited visual fields develop. With advanced adenoma, atrophy of the optic nerves may occur.
If the formation grows upward, it causes mental disturbances. With the germination of the bottom of the Turkish saddle and spreading to the nasal sinuses, the patient has signs of nasal tumors and sinusitis.
Pregnancy
Similar concepts are often incompatible. The bottom line is that education often causes excessive prolactin products, which negatively affects the fertility of patients of both sexes.
In addition, pituitary formations are often accompanied by menstrual irregularities, and sometimes complete cessation of menstruation. But even if menstruation goes, difficulties can arise when fertilization.
Than dangerous?
In most clinical cases, pituitary adenomas grow to a small size and do not cause patients special anxiety.
Similar formations are characterized by slow growth and extremely benign nature, however, in exceptional cases, there is a likelihood of malignancy.
Sometimes, the adenoma sprouts into the cerebrospinal structures and squeezes them, causing neurological disorders, visual disturbances, numbness of the face, and chronic headaches.
If the adenoma is characterized by intensive growth, as a result, it disrupts the hormonal status of the patient, causing a disruption in the activity of many systems - sexual, adrenal, thyroid, etc.
Diagnosis
The process for determining and confirming the pituitary adenoma usually involves the following procedures:
- Radiographic study of the Turkishsaddles;
- Magnetic resonance imaging of cerebrospinal structures;
- Computerized tomography of the skull;
- Headache angiography;
- Study of pituitary hormones by radiological method;
- Ophthalmoscopy, etc.
Treatment of cerebral pituitary adenoma
The choice of the therapeutic approach is determined by the individual features of the clinical case, the size of the formation, hormonal activity, etc. Hormoneally inactive tumors are treated primarily operatively, supplementing the surgical removal by irradiation.
For prolactinomas with a high prolactin level, drug therapy is recommended, and at a low level of this hormone, surgery is indicated.
Operation
Operations are performed in cases where the size of the adenoma reaches significant values or there are various complications such as cyst formation, visual disturbances or hemorrhages. In general, surgical interventions are performed transnasal or transcranial.
In the transnasal method, the removal of the formation is carried out through the nasal cavity, and in transcranial operation, the patient is subjected to trepanation of the skull, in which a tumor is excised through the formed opening.
Consequences of
Surgical removal of the pituitary adenoma is fraught with functional disorders of adenohypophysial activity.
Among the frequent consequences of this treatment experts call:
- Adrenal cortical dysfunction;
- Visual impairment, up to total loss;
- Pituitary blood circulation disorders;
- Problems with thyroid function;
- No sexual desire and erectile dysfunction.
Reviews
Elena, Norilsk:
Before the operation of the saw for 3 months, Dostinex, prolactin fell to 500. Then the operation was performed transnazalnym way in the Moscow Research Institute of Burdenko. Everything went fine, already 4 years after the operation was over. The body was fully restored. We have doctors from God.
Anna, Nizhnevartovsk:
I also received an adenoma of the pituitary gland. The doctor categorically said that only to operate. I was afraid for a long time, pulled, even wanted to do a cyber-knife operation, but it turned out that after her often recurrences happen. Therefore they did transnazalno. While I drink medicine, but soon the course ends. So, everything is fine.
The cost of
The most gentle, and therefore the preferred way to remove the pituitary adenoma is transnasal removal. The average cost of such an operation is about 36 000-120 000₽.
As for the traditional surgical operation, its specific price depends on the complexity of the intervention, the status of the clinic and the additional procedures.
On average, it does not exceed 60 000₽, and in medical institutions of state significance these operations are performed free of charge.
The removal of pituitary formations with the help of a cyber knife will cost 80 000 ₽ and more. Such an operation is available only in private clinics.
Medical treatment
Medication therapy for pituitary adenomas involves the use of drugs like:
- Cortisol production inhibitors;
- Serotonin antagonists;
- Somatostatin analogues of the Octreotide type;
- Dopamine agonists such as Kabergoline or Bromocriptine, etc.
As a result of this therapeutic campaign, stable stabilization of the hormonal status is observed in approximately 31% of cases, and in 55% of cases adenomas regress.
Radiation therapy
Irradiation is usually used as an auxiliary therapeutic technique, but can also be used for microadenomas characterized by low activity. Most often radiotherapy is used in combination with conservative treatment. Sometimes patients undergo gamma therapy when the radiation is directed from a source located outside the patient's body.
Folk remedies
To treat such a serious disease, focusing on folk methods and questionable recipes from the Internet, it is quite dangerous. Folk healers recommend taking medicines based on herbal medicines containing herbs like licorice, marigold, oregano, etc.
But when the first pathological manifestations occur, mandatory qualified counseling is required, otherwise self-medication can lead to death.
Forecast
Pituitary adenomas are benign lesions, but with active growth, they can cause a lot of problems and even degenerate into a malignant process.
If the tumor is large( more than 2 cm), then the risk of its recurrence is great in the next 5 years after prompt removal.
An important role in predicting such formations is the nature of the adenoma. For example, in the case of prolactinomas or somatotropinomas, a quarter of patients have complete recovery of endocrine activity, with microcorticotropinomas 85% of patients recover completely.
Video of endoscopic removal of pituitary adenoma: