The pituitary gland is a small cerebral appendage that plays an important role in human physiology. Functions of the pituitary gland consist in the development of hormones that affect growth, reproduction and metabolic processes in the body. This body is the center of the human endocrine system.
Pituitary tumors: neurological aspect of
disease Abnormal multiplication of pituitary cells leads to the formation of tumors on its anterior and posterior surfaces, which leads to a disruption of hormone balance in the body and neurological problems of various nature.
Pituitary tumors with the same frequency are observed in both men and women, the most frequent age in which the disease is diagnosed - 30-40 years.
In some cases there is a germination in the pituitary gland of the meninges, which also has a negative effect on the gland.
Sometimes neoplasms in the pituitary gland do not have any tangible effects on the body.
Causes of tumors of the pituitary gland
Modern medicine has not yet determined the causes that directly affect the appearance of tumors of the pituitary gland.
In a number of cases, the hereditary factors play a fatal role. Possible risk factors leading to the development of neoplasms include:
- of the nervous system;
- chronic sinusitis;
- head injury;
- reception of hormonal medicines;
- exposure during pregnancy to the fetus of adverse factors;
There is also a scientific theory, according to which the abnormal growth of the pituitary gland can begin due to insufficient productive activity of the peripheral glands of the endocrine system or an excess of hormones of the hypothalamus.
There is one more theory explaining the causes of pituitary transformations by a genetic disorder in one of its cells.
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Pituitary tumors are more often benign( they are also called adenomas) than malignant ones.
In the first case, neoplastic cells continue to partially retain properties and functions inherent in similar healthy cells. Benign tumors are characterized by slow growth. Growing up, they gradually squeeze the surrounding tissues, but almost never penetrate them. Such tumors are well suited for surgical removal: cases of relapses are very rare.
Malignant cells undergo significant transformation and completely lose the ability to control growth and differentiation. Such cells can not perform their functions.
Malignant tumors have the ability to germinate in surrounding tissues, organs, blood and lymph vessels. They are characterized by rapid and aggressive growth and the formation of metastases.
Malignant tumors are difficult to treat, often recur. The operability of a specific tumor depends on the stage of its development.
The most common form of pituitary neoplasms, which in medicine are called adenomas. They are classified by their size.
- picoadenomas( size - less than 3 mm)
- microadenomas( size - less than 1 cm);
- macroadenomas( size - more than 1 cm);
- giant adenomas;
Depending on the functional activity of the gland, the tumors are:
- hormone-active( producing hormones);
- hormonal-inactive( mute, not involved in the synthesis of hormones);
The hormonal-active adenomas are subdivided, in turn, into:
- prolactinomas( tumors that produce the prolactin hormone);
- corticotropinomas( adenomas that release corticosteroid hormones);
- somatotropinomas( synthesizing somatropin - growth hormone);
- thyrotropinomas( tumors that produce a hormone that stimulates the thyroid gland);
- gonadotropins( regulating the production of sex hormones);
Symptoms of pituitary tumors and course of the disease( neuroanatomical manifestations)
In addition to endocrine disorders caused by tumors and leading to gland hyperfunction or hypofunction, neoplasms also affect neuroanatomy and human neurophysiology.
An increase in the size of the tumor results in an increasing pressure on the medulla. This leads to neurological problems:
- headaches of varying intensity and localization;
- of neuralgia;
- to migraines;
- of vegetative-vascular dystonia;
- for insomnia;
- to nervous tics;
- double vision and nystagmus( jittery eyeballs);
- persistent cold;
- dementia( dementia) and personality changes;
Headache for pituitary tumors
Pain, depending on the classification of the neoplasm itself, can arise in the frontal, temporal and infraorbital areas. The pain is usually dull, constant, not accompanied by nausea, deterioration of vision and does not depend on the position of the body.
This pain reacts poorly to analgesics. In the event that there is a rupture of the medullary membrane due to the excessive pressure of the tumor on the latter, the pain usually ceases. However, this does not mean that the problem was resolved.
Further growth of the tumor exerts pressure on the optic nerves and visual crosstalk( part of the brain where a significant portion of the optic nerve fibers intersect).This leads first to defects in the field of vision, then to atrophy( dying out) of the optic nerves and complete blindness.
Tumor pressure on the hypothalamus
Further tumor overgrowth and its pressure on the hypothalamus can trigger the following symptoms:
- temperature fluctuations;
- hyperphagia( overeating due to abnormal craving for food caused by a mental disorder);
- sleep disturbances;
- emotional shifts;
Influence of the tumor on the ventricles of the brain
When pressure on the ventricles of the brain can develop hydrocephalus( edema of the brain).When squeezing the temporal or frontal cerebral lobes, seizures, diplopia( double vision) and ophthalmoplegia( paralysis of the eye nerves) may occur.
Growth of a pituitary tumor down can lead to the rupture of the "Turkish saddle" of the brain and the spread of the pathological process on the sinuses of the nose, which can lead to the escape from the nose of the cerebrospinal fluid.
The growth of the adenoma is usually slow, and its symptoms appear gradually, but in some cases, sudden hemorrhage or apoplexy( pituitary rupture) may occur. These complications cause complete atrophy of the pituitary gland and serious visual disturbances, right up to blindness.
In rare cases, tumors are diagnosed in children. For a pituitary tumor, children have the same symptoms as adults. Sometimes they can manifest themselves even earlier, because children are more susceptible to all changes occurring in the body.
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General Diagnosis of Pituitary Tumors and Neuroendgenological Data of
Some clinical manifestations of pituitary tumors, as well as biochemical signs, indicate the presence of a tumor directly-for example, gigantism in children, acromegaly( enlargement of certain facial and body parts) in adults, or Itzenko-Cushing's disease, also causingcharacteristic changes in the external appearance of the patient.
If a tumor is suspected,
- needs to perform a thorough hormonal and ophthalmologic examination of the patient. Analyzes of blood and urine allows you to determine the presence and level of hormones, and examination of the organs of vision allows you to judge the size of the tumor and the direction of its growth.
- to investigate cerebrospinal fluid for the presence of proteins in it, as this may also be an indirect sign of the presence of tumors in the brain.
- for neurological imaging of pituitary neoplasms to make radiography, computed tomography and magnetic resonance imaging( angiography) of the brain.
Microadenomas and picoadenomas can only be diagnosed using magnetic resonance imaging and computer tomography. This method allows you to determine the exact location of the tumor and its size.
The photo shows a tumor of the pituitary gland found during the hardware examination:
Treatment of tumors of the pituitary gland
Therapy of tumors of the pituitary gland depends on the classification of the tumor. It is used medicinal, radiotherapy( radiosurgical), traditional surgical and complex treatment.
Drug treatment is the use of dopamine agonists, causing the proliferation of adenomas and corticotropin. Among drugs for the treatment of brain tumors - cabergoline, cyproheptadine and bromocriptine and other medications that regulate the level of hormones in the body.
Radiosurgical treatment is used in the presence of factors that do not allow for routine surgical intervention, as well as in elderly patients. Doses of radiation depend on the size and type of tumors. The effect of radiation therapy is observed with long-term use of the method( from 3 to 10 and more years).
Radiation therapy has a number of contraindications( for example, the tumor should not be too close to the optic nerves) and has side effects.
There are more innovative methods of radiosurgery - a cyber knife and a gamma knife.
The tumor is irradiated from different sides with thin beams of radiation. The procedure is carried out with constant monitoring of computed tomography. The main advantage of radiosurgery is its absolute non-invasiveness.
This method is the most effective.
When choosing the method of surgical intervention, the value has localization of the adenoma and its size. The tumor is removed either frontal by means of an optical device, or by resection through the wedge-shaped cranial bone.
In modern surgery, removal of adenomas is increasingly carried out using endonasal transsphenoidal intervention - i.e.through the nasal passage. This method is most safe, does not require cuts and does not lead to complications in the form of infection.
Penile nasal penetration into the cranial cavity is performed using miniature surgical instruments and an endoscopic probe.
Mixed types of treatment
In the complex therapy after surgical removal of the tumor, there is a full-beam radiotherapy, as well as medical hormonal treatment.
Predictions and Implications for Pituitary Tumors
Prognosis for tumors depends on timely diagnosis, adenoma size and their hormonal activity. Prolactinomas and somatotropinomas are completely curable only in 25% of cases, other types of tumors are successfully treated in 80%.Restoration of the optic nerves is possible only at the initial stage of the pathological processes that affected them.
All you need to know about pituitary tumors: