Pituitary adenoma: types of neoplasms, symptoms and treatment. Pituitary microadenoma: causes, consequences, signs, how and when to treat Pituitary adenoma causes

This is a tumor formation of a benign nature, emanating from the glandular tissue of the anterior pituitary gland. Clinically, pituitary adenoma is characterized by ophthalmic-neurological syndrome (headache, oculomotor disorders, double vision, narrowing of visual fields) and endocrine-exchange syndrome, in which, depending on the type of pituitary adenoma, gigantism and acromegaly, galactorrhea, sexual dysfunction, hypercorticism, hypo - or hyperthyroidism, hypogonadism. The diagnosis of "pituitary adenoma" is established on the basis of radiography and CT of the Turkish saddle, MRI and angiography of the brain, hormonal studies and ophthalmological examination. Pituitary adenoma is treated with radiation exposure, radio surgical method, as well as by transnasal or transcranial removal.

General information

The reasons

Etiology and pathogenesis of pituitary adenoma in modern medicine remain the subject of research. It is believed that a neoplasm can occur when exposed to such provoking factors as traumatic brain injury, neuroinfections (tuberculosis, neurosyphilis, brucellosis, poliomyelitis, encephalitis, meningitis, brain abscess, cerebral malaria, etc.), adverse effects on the fetus during its intrauterine development. Recently, it has been noted that pituitary adenoma in women is associated with prolonged use of oral contraceptives.

Studies have shown that in some cases, pituitary adenoma occurs as a result of increased hypothalamic stimulation of the pituitary gland, which is a response to the primary decrease in the hormonal activity of the peripheral endocrine glands. A similar mechanism for the occurrence of adenoma can be observed, for example, in primary hypogonadism and hypothyroidism.

Classification

Clinical neurology divides pituitary adenomas into two large groups: hormonally inactive and hormonally active. The pituitary adenoma of the first group does not have the ability to produce hormones and therefore remains the responsibility of neurology exclusively. The pituitary adenoma of the second group, like the tissues of the pituitary gland, produces pituitary hormones and is also the subject of study for endocrinology. Depending on the secreted hormones, hormonally active pituitary adenomas are classified into:

• somatotropic (somatotropinomas)
• prolactin (prolactinomas)
• corticotropic (corticotropinomas)
• thyrotropic (thyrotropinomas)
• gonadotropic (gonadotropinomas).

Depending on its size, a pituitary adenoma may refer to microadenomas - tumors up to 2 cm in diameter or macroadenomas with a diameter of more than 2 cm.

Symptoms of pituitary adenoma

Clinically, pituitary adenoma is manifested by a complex of ophthalmic and neurological symptoms associated with the pressure of a growing tumor on intracranial structures located in the area of ​​the Turkish saddle. If the pituitary adenoma is hormonally active, then in its clinical picture, the endocrine-metabolic syndrome may come to the fore.

Changes in the patient's condition are often associated not with the hyperproduction of the tropic pituitary hormone itself, but with the activation of the target organ on which it acts. Manifestations of endocrine-exchange syndrome directly depend on the nature of the tumor. On the other hand, a pituitary adenoma may be accompanied by symptoms of panhypopituitarism, which develops due to the destruction of pituitary tissue by a growing tumor.

Ophthalmo-neurological syndrome

Ophthalmo-neurological symptoms that accompany pituitary adenoma largely depend on the direction and prevalence of its growth. Typically, these include headache, visual field changes, diplopia, and oculomotor disturbances. The headache is due to the pressure that the pituitary adenoma exerts on the sella turcica. It has a dull character, does not depend on the position of the body and is not accompanied by nausea.

Patients with a pituitary adenoma often complain that they are not always able to relieve headaches with analgesics. The headache that accompanies a pituitary adenoma is usually localized in the frontal and temporal regions, as well as behind the orbit. Perhaps a sharp increase in headache, which is associated either with hemorrhage in the tumor tissue, or with its intensive growth.

Restriction of visual fields is caused by compression of the growing adenoma of the optic chiasm, located in the region of the Turkish saddle under the pituitary gland. A long-standing pituitary adenoma can lead to atrophy optic nerve. If the pituitary adenoma grows laterally, then over time it compresses the branches of the III, IV, VI and V cranial nerves.

As a result, there is a violation of the oculomotor function (ophthalmoplegia) and doubling (diplopia). There may be a decrease in visual acuity. If a pituitary adenoma grows into the bottom of the Turkish saddle and spreads to the ethmoid or sphenoid sinus, then the patient develops nasal congestion, mimicking the clinic of sinusitis or nasal tumors. The upward growth of the pituitary adenoma causes damage to the structures of the hypothalamus and can lead to the development of impaired consciousness.

Endocrine-metabolic syndrome

Metabolic and endocrine disorders are characteristic of adenomas that actively produce hormones. Clinical manifestations correspond to what type of pituitary hormone is produced by the tumor. The following clinical options are possible:

• Somatotropinoma- pituitary adenoma producing growth hormone, in children is manifested by symptoms of gigantism, in adults - acromegaly. In addition to characteristic skeletal changes, patients may develop diabetes and obesity, an increase thyroid gland(diffuse or nodular goiter), usually not accompanied by it functional disorders. Often there is hirsutism, hyperhidrosis, increased greasiness of the skin and the appearance of warts, papillomas and nevi on it. Perhaps the development of polyneuropathy, accompanied by pain, paresthesia and decreased sensitivity of the peripheral parts of the limbs.
• Prolactinoma- pituitary adenoma secreting prolactin. In women, it is accompanied by menstrual irregularities, galactorrhea, amenorrhea, and infertility. These symptoms may occur in combination or be observed in isolation. About 30% of women with prolactinoma suffer from seborrhea, acne, hypertrichosis, moderate obesity, anorgasmia. In men, ophthalmo-neurological symptoms usually come to the fore, against which galactorrhea, gynecomastia, impotence and decreased libido are observed.
• Corticotropinoma- pituitary adenoma producing ACTH is detected in almost 100% of cases of Itsenko-Cushing's disease. The tumor manifests itself with classic symptoms of hypercortisolism, increased skin pigmentation as a result of increased production along with ACTH and melanocyte-stimulating hormone. Mental deviations are possible. A feature of this type of pituitary adenoma is the tendency to malignant transformation with subsequent metastasis. Early development serious endocrine disorders contributes to the detection of a tumor before the appearance of ophthalmic-neurological symptoms associated with its increase.
• thyrotropinoma- TSH-secreting pituitary adenoma. If it is primary, then it manifests itself as symptoms of hyperthyroidism. If it occurs again, then hypothyroidism is observed.
• Gonadotropinoma- pituitary adenoma, producing gonadotropic hormones, has nonspecific symptoms and is detected mainly by the presence of typical ophthalmo- neurological symptoms. In its clinical picture, hypogonadism can be combined with galactorrhea caused by hypersecretion of prolactin by the pituitary tissues surrounding the adenoma.

Diagnostics

Patients in whom pituitary adenoma is accompanied by a pronounced ophthalmic-neurological syndrome, as a rule, seek help from a neurologist or ophthalmologist. Patients in whom pituitary adenoma is manifested by endocrine-metabolic syndrome often come to an appointment with an endocrinologist. In any case, patients with suspected pituitary adenoma should be examined by all three specialists.

In order to visualize the adenoma, an x-ray of the Turkish saddle is performed, which reveals bone signs: osteoporosis with the destruction of the back of the Turkish saddle, a typical bypass of its bottom. Additionally, pneumocisternography is used, which determines the displacement of the chiasmal cisterns from their normal position.

More accurate data can be obtained during CT of the skull and MRI of the brain, CT of the Turkish saddle. However, about 25-35% of pituitary adenomas are so small that their visualization fails even with modern tomography capabilities. If there is reason to believe that the pituitary adenoma is growing towards the cavernous sinus, brain angiography is prescribed.

Hormonal studies are of great importance in the diagnosis. Determination of the concentration of pituitary hormones in the blood is carried out by a specific radiological method. Depending on the symptoms, the hormones produced by the peripheral endocrine glands are also determined: cortisol, T3, T4, prolactin, estradiol, testosterone.

Ophthalmic disorders that accompany pituitary adenoma are detected during an ophthalmological examination, perimetry, visual acuity testing. Ophthalmoscopy is performed to exclude eye diseases.

Treatment of pituitary adenoma

Conservative treatment can be used mainly for small prolactinomas. It is carried out with prolactin antagonists, for example, bromocriptine. With small adenomas, it is possible to use radiation methods to influence the tumor: gamma therapy, external beam or proton therapy, stereotactic radiosurgery - injection of a radioactive substance directly into the tumor tissue.

Patients in whom a pituitary adenoma is large and/or accompanied by complications (hemorrhage, visual impairment, brain cyst formation) should undergo a consultation with a neurosurgeon to consider the possibility surgical treatment. The operation to remove the adenoma can be performed transnasally using endoscopic techniques. Macroadenomas are subject to removal by a transcranial method - by craniotomy.

Forecast

Pituitary adenoma refers to benign neoplasms, however, with an increase in size, it, like other brain tumors, takes on a malignant course due to compression of the anatomical structures surrounding it. The size of the tumor also determines the possibility of its complete removal. A pituitary adenoma with a diameter of more than 2 cm is associated with the likelihood of postoperative recurrence, which can occur within 5 years after removal.

The prognosis of adenoma also depends on its type. Thus, with microcorticotropinomas, 85% of patients have a complete recovery of endocrine function after surgical treatment. In patients with somatotropinoma and prolactinoma, this figure is much lower - 20-25%. According to some data, on average, after surgical treatment, recovery is observed in 67% of patients, and the number of relapses is about 12%. In some cases, with hemorrhage into the adenoma, self-healing occurs, which is most often observed with prolactinomas.

Pituitary adenoma, the symptoms, treatment and diagnosis of which are described in general terms in this article, is a benign tumor located in its anterior lobe. According to statistics, pituitary adenomas account for about 10-18% of the total number of intracranial tumors, they are equally common in men and women, mainly at the age of 20-50 years.

What are adenomas?

Pituitary adenoma, depending on its constituent cells, can be hormonally active and inactive (60% and 40% of cases, respectively). In turn, almost all hormonally active adenomas produce any one hormone of the anterior pituitary gland, and 10% of tumors produce several hormones at once.
Hormonally active tumors, depending on the hormones they produce, are of the following types:

1. Gonadotropic adenoma (produces hormones that stimulate the sex glands: follicle-stimulating and luteinizing hormone).
2. Thyrotropinoma (produces thyroid-stimulating hormone that controls work).
3. Corticotropinoma (synthesizes adrenocorticotropic hormone, which is responsible for the production of glucocorticoids by the adrenal glands).
4. Somatotropinoma (secretes growth hormone responsible for body growth, protein synthesis, fat breakdown and glucose formation).
5. Prolactinoma (produces prolactin, which causes milk production).
6. Mixed adenomas (produce several hormones at the same time).

Depending on the size of the tumor, all pituitary adenomas are divided into micro- and macroadenomas. Microadenomas may not be detected even during MRI, and they are periodically detected during post-mortem autopsies, which are performed for completely different diseases.

In the normal state, the pituitary gland is located in the deepening of the sphenoid bone of the skull, which is called the Turkish saddle. In relation to the natural location of the pituitary gland in this saddle, adenomas can grow both inside this recess and go beyond it, therefore, according to the nature of tumor growth, adenomas are divided into:

• endosellar (located inside the saddle);
• endoinfrasellar (grow down);
• endosuprasellar (going up);
• endolaterosellar (the tumor goes to the right or left in relation to the Turkish saddle);
• mixed (for example, located obliquely).

Why does an adenoma occur?

The reasons for the development of pituitary adenoma are not exactly established. In general, it is believed that some types of adenomas arise as a result of excessive stimulation from the hypothalamus or insufficiency of the functioning of the endocrine glands, which are "subordinate" to the pituitary gland.
Factors that contribute to the appearance of adenoma are:

• traumatic brain injury;
• infectious diseases brain (for example,);
• long-term use of oral contraceptives.

Pituitary adenoma: symptoms

All symptoms that may accompany pituitary adenoma can be conditionally divided into 2 large groups (syndromes):

1. Syndromes arising from mechanical compression of the surrounding tissues by the adenoma.
2. Endocrine-exchange syndromes.

Syndromes of mechanical compression

Mechanical compression and destruction of surrounding tissues cause rather large adenomas (macroadenomas). In this case, the symptoms are closely related to the direction in which the tumor grows relative to the Turkish saddle.
Up (endosuprasellar adenomas). On top of the pituitary gland is the optic chiasm, so such adenomas often lead to visual impairment such as:

• change in visual fields (for example, according to the type of bitemporal hemianopsia, see below);
• complete blindness.

If the field of view of each eye is mentally divided in the middle by a vertical line, then you get 2 semicircles: the outer one (the one with the convex part facing the temple - temporal, temporal) and the inner one (the bulge facing the bridge of the nose - nasal). Bitemporal hemianopsia is when a person continues to see only with the inner, nasal halves, and the temporal halves of both eyes become blind.

Also, as it grows upward, the tumor begins to put pressure on the diaphragm of the Turkish saddle, causing a dull headache in the frontotemporal region, which does not depend on a change in body position, is not accompanied by vomiting, and often does not go away after taking painkillers.

Very large pituitary macroadenomas growing in this direction can even compress the third ventricle (one of the brain cavities through which cerebrospinal fluid circulates), resulting in symptoms of increased intracranial pressure: vomiting, severe headache.
Downward (endoinfrasellar adenomas). In this case, the adenoma can gradually destroy the bottom of the Turkish saddle and spread directly into the sinus of the sphenoid or ethmoid bone. This may be accompanied by a feeling of nasal congestion and a "runny nose", although in fact it is cerebrospinal fluid leaking from the cranial cavity.
To the sides (endolaterosellar adenomas). On the sides of the pituitary gland are various cranial nerves involved in movement. eyeballs as well as the optic nerve. In this case, the most characteristic symptoms will be the following:

• decreased vision;
• double vision;
• strabismus;
• drooping eyelids.

In addition, an adenoma can compress other parts of the pituitary gland, causing their complete or partial death. As a result, pituitary insufficiency is gradually formed:. The main symptoms of hypopituitarism are:

• obesity or malnutrition;
• in women - atrophy of the uterus, ovaries, mammary glands;
• in men - atrophy of the penis, testicles;
• lethargy;
• noise in ears;
• headache;
• fast fatiguability;
• drowsiness;
• decrease in metabolic rate.

Endocrine-exchange syndrome

Hormonally active pituitary adenomas can be detected at an early stage due to the fact that, by synthesizing an increased amount of certain hormones, they cause hormonal changes throughout the body, even in cases where the tumor itself is quite small.

Prolactin-producing adenoma (prolactinoma)
In women - menstrual irregularities, milk secretion (), infertility; overweight, acne, decreased libido can also be observed.
For men, an increase mammary glands(gynecomastia), decreased libido, impotence.
Somatotropic hormone-producing adenoma (somatotropinoma)
Children have gigantism.
In adults - the phenomena of acromegaly (large zygomatic arches, auricles, nose, etc.).
Producing adenoma (corticotropinoma)
It is characterized by symptoms of hypercortisolism and is very often found in Itsenko-Cushing's disease. The following symptoms are most characteristic of hypercortisolism:

• rounded, moon-shaped face;
• a decrease in the amount of muscle tissue;
• acne;
• increased skin pigmentation;
• increased blood pressure;
• decreased libido;
• accompanied by spontaneous fractures of the ribs;
• headache;
• general weakness.

Adenoma that synthesizes an excessive amount of thyroid-stimulating hormone (thyrotropinoma)
This adenoma leads to thyrotoxicosis, which is accompanied by:

• increased heart rate;
• characteristic bulge;
• weight loss, etc.

Sex hormone-producing adenoma (gonadotropinoma)
In women - menstrual irregularities.
In men - gynecomastia, impotence.

Diagnosis, treatment and prevention

At home, you can notice some of the signs that were listed above. However, for an accurate diagnosis, it is necessary to visit a neurologist and undergo a more in-depth examination, which may include X-ray of the skull bones (in various projections), MRI, CT, and hormonal levels (for example, a study of the level of hormones of the anterior pituitary gland).

BRAIN PITUITARY ADENOMA - WHAT IS IT?

The pituitary gland is the body's most important gland, as it controls most of the endocrine functions. It consists of two lobes: anterior and posterior. The anterior pituitary secretes 6 hormones: thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH, or growth hormone) and prolactin (PL). The posterior lobe secretes vasopressin and oxytocin. When a tumor growth occurs from hormonal cells, they speak of a pituitary adenoma.

Pituitary adenomas are almost always benign and have no malignant potential. According to their functional properties, glandular tumors are divided into secreting and non-secreting tumors, other intrasellar tumors and parasellar tumors. The latter group are tumors that occur near the sella turcica and may resemble pituitary tumors in terms of the symptoms they cause. Hormonally inactive tumors up to several millimeters in size are very common and occur in about 25% of autopsy material. They can grow slowly, disrupting the normal hormonal function of the gland (hypopituitarism), or they can compress underlying brain structures, causing neurological symptoms.

Secreting, or hormonally active, adenomas are clinically divided into several types depending on the hormones they secrete. These tumors cause specific symptoms due to their secretion of hormones, but rarely grow large enough to compress adjacent structures. As the tumor grows, normal pituitary tissue is destroyed, leading to many hormonal disorders. In rare cases, spontaneous hemorrhages into the tumor or heart attacks are observed. Pressure exerted by tumors on adjacent structures can cause facial numbness and double vision. Directly above the pituitary gland is the optic chiasm (chiasm), so tumors can cause progressive loss of vision. Vision loss usually begins in both visual fields and leads first to tunnel vision and then to blindness.

PITUITARY TUMOR: SYMPTOMS IN MEN AND WOMEN

Symptoms associated with the secretory activity of the tumor

The clinical signs of a pituitary adenoma vary considerably depending on the location and size, as well as the ability of the tumor to secrete hormones. Pituitary adenomas usually occur at a fairly young age, regardless of gender. Hormonally active adenomas are usually small and do not cause neurological symptoms or hypopituitarism, but the reverse is also possible. Symptoms of a hormonally active tumor are associated with the action of the specific hormone that it produces.

Neurological symptoms of pituitary adenomas include headaches, diplopia; loss of peripheral vision leading to blindness, facial pain or numbness. Hypopituitarism is manifested by severe weakness, weight loss, nausea, vomiting, constipation, amenorrhea and infertility, dry skin, increased skin pigmentation, increased chilliness, and changes in mental status (eg, drowsiness, psychosis, depressive disorders).

Prolactinoma is the most common pituitary tumor in women. Signs of a pituitary tumor in women due to prolactinoma include amenorrhea (absence of spotting during menstruation), menstrual irregularity, galactorrhea (milk from the nipples), female infertility and osteoporosis. Hypogonadism, loss of libido, and impotence in men can also be associated with prolactinoma.

Signs of pituitary adenoma in women are due to the type of hormone that tumor cells produce. The most common variant is prolactinoma, which causes pathological activity of the mammary glands.

Tumors that secrete excess GH cause gigantism in children and acromegaly in adults. In acromegaly, enlargement of facial features, enlarged hands and feet, heart disease, hypertension, arthritis, carpal tunnel syndrome, amenorrhea, and impotence are observed.

Pituitary adenoma - symptoms in a middle-aged man. Acromegaly, observed with increased production of somatotropic hormone by a pituitary tumor. Along with high growth, there is an increase in the nose, mandible, superciliary arches.

ACTH-secreting adenomas lead to the development of Cushing's disease, which, in turn, is characterized by a round face with acne and flushing, fat deposits on the back of the neck, stretch marks and a tendency to bruise the skin, excessive growth of body hair, diabetes mellitus, muscle loss, fatigue, depression and psychosis.

Tumors that secrete TSH are characterized by thyrotoxicosis symptoms such as heat intolerance, sweating, tachycardia, mild tremors, and weight loss. Some secrete more than one hormone, such as GH and PL at the same time.

Less common are tumors that secrete LH or FSH (gonadotropins). When the tumor begins to affect the secretory cells of the pituitary gland, the first signs of secretory insufficiency usually relate to the functions of gonadotropins. Thus, the first sign of pituitary adenoma in women may be the cessation of menstruation. In men, the most common sign of hormonal deficiency of gonadotropins is impotence. Rarely, there is an isolated deficiency of LH or FSH. In men, isolated LH deficiency leads to the development clinical picture fertile eunuch. In this state normal level FSH allows sperm maturation to be achieved, but due to LH deficiency, the patient may develop signs of hormonal castration. Tumors can also produce excess amounts of LH or FSH; in addition, tumors that secrete only nonspecific hormonally inactive alpha subunits of glycoprotein hormones are not uncommon.

Symptoms associated with compression of surrounding structures

Pituitary adenomas are conditionally divided into microadenomas (up to 1 cm in size) and macroadenomas (>1 cm in size). If the former usually do not cause a volumetric effect on the brain or nerves due to their small size, then the latter, as they grow, more and more compress the surrounding tissues.

Visual disturbances are usually associated with compression of the structures of the visual analyzer pathway and include bitemporal narrowing of the visual fields, color vision impairment, double vision, and ophthalmoplegia. In the study of the fundus, a sign of prolonged compression of the optic chiasm is, first of all, atrophy of the optic nerve. Severe optic nerve atrophy indicates a poorer prognosis for visual recovery after surgical decompression. In pregnant women, bitemporal visual field constriction and headache may indicate pituitary apoplexy.

Pituitary apoplexy is a potentially life-threatening condition. Pregnant women with pituitary adenomas and MRI signs of subarachnoid hemorrhage require caesarean section to avoid pituitary apoplexy during childbirth. Postpartum hemorrhage can cause pituitary infarction with subsequent development of hypopituitarism (Sheehan's syndrome).

HOW TO DIAGNOSIS A PITUITARY TUMOR?

The clinical diagnosis of a pituitary adenoma is based on a combination of signs and symptoms, depending on the size of the tumor and the hormones it secretes.

A radiograph of the sella turcica in a lateral view in a patient with pituitary adenoma shows an enlarged sella turcica and areas of calcification in the adenoma (arrow).

If in the past decades the main method of visualizing the pituitary gland was radiography of the sella turcica, then in last years CT and MRI have completely supplanted it, since standard radiography does not show well soft tissues, in contrast to tomographic methods, which display the human body in the form of many sections. Today, radiography of the Turkish saddle should not be prescribed, since its information content is low, there is radiation exposure, and most importantly, the decision on the tactics of treating adenoma is made on the basis of modern methods such as CT and MRI.

Standard single-slice CT has very limited utility in pituitary imaging; in the diagnosis of microadenomas, the sensitivity of the method is 17-22%. Multislice CT with 64 detectors can be used, especially in patients who cannot have an MRI. CT better visualizes bone structure features and calcifications in tumors such as germinomas, craniopharyngiomas, and meningiomas. CT angiography perfectly visualizes the morphology of parasellar aneurysms and can be used in planning surgical intervention. CT scans are useful in cases where MRI is contraindicated, such as in patients with pacemakers or intraocular/intracerebral metal implants.

In general, MRI is preferable to CT in the diagnosis of pituitary adenomas, as it better determines the presence of small formations in the sella turcica and their anatomical characteristics at the preoperative stage. MRI is also recommended for postoperative follow-up.

It is not uncommon for MRI results to be questionable, unreliable, or controversial. In such cases, it is recommended to re-analyze the images from the disc by an experienced doctor of an expert level. If there is no such doctor nearby, a second opinion can be obtained remotely by contacting the National Teleradiological Network, the All-Russian consultation service for diagnosticians.

Angiography is rarely used; if indicated, standard angiography is replaced by CT or MRI angiography. Angiography plays a role when clarification of the condition of the cavernous sinus or cavernous part of the carotid artery is required.

Somatostatin receptor scintigraphy can be used to differential diagnosis recurrence of the tumor or residual tumor tissue in the area of ​​the scar or tissue necrosis after surgery.

DISADVANTAGES AND LIMITATIONS OF THE METHODS

Standard radiography does not show soft tissue well. MRI is more expensive than CT but is the preferred method for examining the pituitary gland because it better visualizes soft tissue and vascular structures. Thus, the limitations of CT include poorer soft tissue imaging compared to MRI, the need for intravenous contrast to improve images, and radiation exposure to the patient.

A potential limitation to the use of MRI is pneumatization of the anterior sphenoid bone or its calcification, which may resemble the features of blood flow in aneurysms. In addition, MRI is contraindicated in patients with pacemakers or ferromagnetic implants in the brain or eyes. On CT or MRI, residual pituitary adenoma tissue may be difficult to distinguish from radiation-induced fibrosis, especially in patients with clinically inactive pituitary adenomas who lack circulating markers to assess progression or response to treatment

CT AT HYPOPHYSIS ADENOMA

SCINTIGRAPHY OF THE HYPOPHYSIS

In vitro, the presence of somatostatin receptors has been shown in most GH-secreting pituitary adenomas, as well as in some pituitary tumors secreting TSH and PL. These receptors were not always found in inactive adenomas. On MRI or CT, it is difficult to distinguish tumor recurrence or residual tumor tissue from postoperative fibrosis.

Scintigraphic visualization of residual tumor tissue is possible using labeled somatostatin analogues such as indium-111 DTPA (diethylenetriaminepentaacetic acid)-octreotide. This method distinguishes scar tissue from tumor recurrence and helps identify patients who may benefit from somatostatin analogues.

Scintigraphy with pentavalent technetium-99m-DMSA (dimercaptosuccinic acid), or 99 m Tc(V)DMSA is also informative in identifying most pituitary adenomas that secrete GH and PL, as well as hormonally inactive adenomas with a ratio of accumulation in the tumor and surrounding tissues equal to 25. Functional imaging of residual tumor (greater than 10 mm) using 99 m Tc(V)DMSA reveals viable residual pituitary adenoma tissue.

111 In-DTPA-octreotide scintigraphy is a novel technique that detects somatostatin receptors in many neuroendocrine tumors (eg, pituitary adenomas). This substance is highly sensitive and is an easily traceable marker in determining the presence of somatostatin receptors in pituitary adenomas.

The role of 111 In-DTPA-octreotide scintigraphy in the detection of hormonally inactive pituitary tumors has not yet been established. Treatment with unlabeled octreotide may likely interfere with labeling by pituitary tumors. Thus, patients who are scheduled for scintigraphy should stop treatment for 2-3 days before the study.

BRAIN PITUITARY ADENOMA - TREATMENT

Pituitary tumors that do not cause endocrine disruption and do not compress surrounding tissues do not require treatment. In such cases, they are limited to observation in the form of repeated MRI studies, preferably with a second opinion. When symptoms appearThe treatment depends on the type of tumor, its size, and the extent to which it affects the brain or nerves. Also mattersage and general health.

Treatment decisions are made by the group medical professionals including a neurosurgeon, an endocrinologist, and sometimes an oncologist.Doctors usually use surgery, radiation therapy, or drug therapy both alone and in combination.

OPERATION TO REMOVE PITUITARY ADENOMA

Surgical removal of a pituitary tumor is usually necessary if the tumor is pressing on the optic nerves, or if the tumor is overproducing certain hormones.The success of the operation depends on the type of tumor, its location, its size, and whether the tumor has invaded surrounding tissues. Before surgery, it is necessary to accurately assess changes in MRI images, and MRI interpretation by an experienced neuroradiologist is necessary. After removal of the pituitary adenoma, nasal discharge may disturb for some time.

The two main surgical treatments for pituitary tumors are:

Endoscopic transnasal transsphenoidal approach. This technique is the removal of a pituitary adenoma through the nose and paranasal sinuses without an external incision. At the same time, brain tissue and cranial nerves remain intact. There is also no visible scar. Large tumors are difficult to remove with the indicated access,especially if the tumor has invaded nearby nerves or brain tissue.

Transcranial access (craniotomy, craniotomy). The tumor is removed through the top of the skull through a hole in its vault.With this technique, it is easier to remove large tumors or formations of a complex structure.

RADIATION THERAPY

Radiotherapy uses high-energy x-rays to target tumors.It can be used after surgery or on its own if surgery does not solve the problem radically. Also lEducational therapy is used with residual tumor tissue, with its recurrence, as well as with the ineffectiveness of drugs.Methods radiotherapy include:

• Gamma Knife - stereotactic radiosurgery.
• Remote gamma therapy.
• Proton beam therapy.

DRUG TREATMENT

Can a pituitary adenoma be cured without surgery? Drug treatment can help block excess hormone secretion and sometimes shrink certain types of pituitary adenomas:

Prolactin-secreting tumors (prolactinomas).The drugs cabergoline and bromocriptine decrease prolactin secretion and reduce tumor size.

Tumors that secrete growth hormone (somatotropinomas).There are two types of medications available for these types of formations:

• somatostatin analogs cause a decrease in growth hormone release and may shrink tumors
  
• pegvisomant blocks the action of excess growth hormone on the body.

Replacement of pituitary hormones. If a pituitary tumor or surgery results in decreased hormone production, you may need to use hormone replacement therapy.

Affects the formation of a benign formation in women, which is called pituitary adenoma. Symptoms in women, treatment, prognosis and possible consequences this serious illness require detailed consideration.

What is a pituitary adenoma?

The pituitary gland itself is a vital gland, the state of which is directly proportional to a balanced hormonal background. human body. This is one of the most common diseases in the brain tissue. Pituitary adenoma is diagnosed in 10 cases out of 100 various kinds original tumors. In addition, the statistics are not encouraging: 20% of women who have crossed the 30-year mark suffer from pathological manifestations in various forms.

Mostly adenomas are a type of tumors that do not have morphological features cancerous. Nevertheless, without the necessary treatment, the likelihood of adenoma degeneration into is quite high. However, it can deliver more danger to neighboring parts of the brain. They are at risk of being squeezed by a tumor prone to sprouting, which usually leads to endocrine disorders, neurological complications, hearing and vision impairment.

Causes and risk groups in women

Despite certain advances in medicine, modern researchers cannot accurately determine the causes of pituitary adenoma. Symptoms in women caused by this pathology can help in determining the sources of the disease and narrow the range of provoking risk factors in each case.

Some scientists believe that the unnatural growth of glandular tissue is due to the low productivity of the peripheral sections. endocrine system organism or with increased production It follows that the causes of pituitary adenoma in women have a diverse nature of origin, and the most common and reliable doctors include the following:

Transferred intracranial injuries (concussions, bruises, hemorrhages);
. infectious diseases affecting the state of the central nervous system (meningitis, poliomyelitis, tuberculosis, encephalitis, syphilis, etc.);
. complications of the intrauterine period;
. regular use of oral hormonal contraceptives;
. radiation exposure;
. change in the structure of DNA at the genetic level.

Often, not only women are at risk, but also men who have a hereditary predisposition or at least one of the above diseases that stimulate the appearance of a tumor. At the same time, pituitary adenoma in women (what it is, many who have encountered this problem in life know) is often provoked by neoplasia, which has been steadily entrenched in several generations of the same family. Development cases this disease in children up to adolescence practically do not occur.

Classification of tumors

A variety of symptoms differ in all developing in the brain, including pituitary adenoma. Symptoms in women appear depending on the species of the disease, which are divided according to the following main criteria:

Type of adenoma - functional (producing hormones) or non-functional (passive);
. tumor size - macroadenomas (more than 10 mm) and microadenomas (up to 10 mm).

The manifestations of non-functional tumors directly depend on the size of the women, the treatment and prognosis of such brain diseases depend on the degree of tumor enlargement. A large tumor has a strong compressive effect not only on the gland itself, but also on other nearby brain structures. The severity of pathological phenomena is determined by the degree of pressure of the neoplasm.

A functionally active pituitary tumor may also increase in diameter. At the same time, the patient is threatened with complications from both hormonal excess and symptoms associated with compression of the enlarged tumor.

Nonfunctional macroadenomas

Signs of pituitary adenoma in women, characteristic of a non-functional type of tumors (more than 1 cm):

Difficulties arise with the definition and perception of colors, shades; all visible objects seem to the patient inexpressive and faded.
. Visual acuity is lost, as a growing tumor, directed forward, touches the optic nerve. The surrounding objects become blurry for the patient, as if with erased edges.
. The ability to see with peripheral vision is lost. In this case, the loss of peripheral vision can be detected only in a complex form of the disease.

Impact of the tumor on the pituitary gland

It is also important that a benign formation, having reached a certain limit value, can interfere with the performance of the pituitary gland of its natural functions, which often leads to pituitary insufficiency. In addition, patients should pay attention to the nature, frequency and frequency of symptoms caused by pituitary adenoma in women. The consequences of the disease in pituitary insufficiency are different in each individual case. Often women do not even pay special attention the following signs:

Infertility (this diagnosis is made due to an intensive decrease in the produced sex hormones);
. hypothyroidism (worsening or complete absence appetite, uncharacteristic fatigue, weight gain, absent-mindedness);
. irregular menstrual cycle(changes in the nature of the manifestation of menstruation, a decrease in discharge and duration of the course);
. adrenal insufficiency (decrease in the production of the hormone cortisol);
. galactorrhea (when breastfeeding).

Symptoms of a functional adenoma

Symptoms of the disease appear depending on which cells formed a functional active pituitary adenoma. Symptoms in women, treatment, prognosis and chances of a successful recovery depend on which hormone is produced in excess. It should be noted that during the diagnosis by physicians, non-functional neoplasms are most often detected. Hormonally active pituitary tumors manifest themselves as follows:

Increase in thyroid-stimulating hormone;
. increased adrenocorticotropic hormone;
. increase in prolactin;
. promotion

A lot of inconvenience and discomfort is brought to patients by the last sign of a present disease, which can be caused by a hormonally active pituitary adenoma. Symptoms in women (photo shown for clarity) with increased production of growth hormone are manifested in a noticeable increase in the arms and legs.

Features and methods of treatment of pituitary adenoma

The main principle on which the entire treatment process is based is not only the provision of positive impact on the benign neoplasm but also the elimination of side effects, negative consequences tumors.

For many cancers that are non-cancerous (such as pituitary adenoma in women), drug-based treatment can be quite effective. However, this applies only to pathologies identified on early stages development.

In most cases, this healing method involves the use of drugs that block growth hormone receptors. More complex treatment options include radiosurgery and neurosurgery. Radiosurgical intervention is optimal only as the last method and is used when the surgical process is not effective enough.

Surgical treatment of the disease

The neurosurgical operation takes about two hours. Penetration into the skull is carried out through the nasal passage. Using a specially designed microscope and other necessary tools, the surgeon reaches the pituitary gland. Upon completion of the operation, the patient will be under the supervision of specialists in the intensive care unit for about a day. The next day, in case of a successful operation and a satisfactory reaction of the body, the patient will be transferred to the general ward. Eating during the first day is contraindicated, but at the end of the first day it is allowed to drink water in small sips, then try to get up and walk. As a rule, the treatment of most of these diseases with the help of neurosurgical intervention ends successfully and is characterized by a rapid rehabilitation period. The pituitary adenoma is no exception. Symptoms in women who have been treated surgically may be postoperative in nature and may be expressed for some time by dizziness, nausea.

Consequences of removal of pituitary adenoma

The chances of recovery are primarily related to how large the pituitary adenoma was. Symptoms in women, treatment, prognosis for recovery, possible consequences - it all depends on the size of the neoplasm. Plan as accurately as possible rehabilitation activities and objectively assess the possibility of recovery will allow fresh clinical indicators obtained as a result of a re-examination. A significant role here is played by the conclusions of the surgeon, ophthalmologist and endocrinologist, which are necessary to compile a complete picture of the patient's condition.

Prognosis for rehabilitation

Turning again to the statistics, you can see that pituitary adenoma in women lends itself to complete recovery in 85 out of a hundred patients. A full restoration of visual abilities depends on how long the organs of vision have been impaired. With a short duration of the disease, the chances of recovery are quite high, but visual function is unlikely to be fully restored in the case of a long course of such a disease as pituitary adenoma in women. Whatever this means, the surgeon's only task can be considered to maintain vision at least at the level at which treatment was started.

The pituitary gland is a rounded appendage of the brain, which is located on the lower surface in the bone pocket. It is responsible for the production of important hormones that stimulate growth, development of the body, and also normalizes reproductive functions. An adenoma is a benign tumor of the glandular upper layer of cells.

Pituitary adenoma in children is considered a rare disease. The percentage of spread is on the border from 2.5 to 6. According to statistics, the tumor most often develops in adults from 20 to 50 years old.

The mechanism of cell growth in pituitary adenoma becomes too fast, so a neoplasm occurs that has multiple complications.

Classification

Pituitary adenoma is divided into types according to several criteria. The sizes distinguish: microadenomas (less than 1 cm), macroadenomas (more than 1 cm), giant tumors (more than 10 cm).

Further classification depends on the type of development of the disease.

non-functional

With this type, there is no mechanism for the production of hormones, the tumor becomes noticeable precisely when it begins to manifest externally, that is, it grows to the point that it presses on tissues and nerves, and also provokes visual impairment.

Producing disease

There is an excessive production of a hormone that is responsible for the normalization of metabolism. An overabundance leads to problems with being overweight, there is a weakening of the bone tissue, which is called "Cushing's syndrome".

Prolactinoma

It is characterized by increased production of prolactin, female hormone. The peculiarity of this neoplasm is that it almost does not grow over time.

There are tumors that provoke the activity of growth hormones. In this case, the bones do not have time to develop as quickly, a conflict occurs, in this case the heart often cannot stand it.

The reasons

It is impossible to name the reasons for the development of a tumor with one hundred percent certainty, there are a number of factors that provoke the development of the disease:

• heredity;
• violations during intrauterine development;
• complex craniocerebral trauma;
• action radioactive substances on the body in large quantities;
• long-term use hormone replacement drugs.

The reason for the development of a tumor can be disorders at the endocrine level, the consequences of infectious diseases.

Symptoms

Depending on the type of adenoma in children, specific symptoms are detected that indicate malfunctions in the body. Some types of neoplasms can grow asymptomatically for a long time, but the child, one way or another, will begin to manifest the disease.

Significant symptoms include:

• rise or fall appetite
• rapid heartbeat, severe sweating;
• fainting;
• constant feeling thirst.

Itsenko-Cushing's disease

This type is rare in children, but when it appears, there is a sharp stop in development. The adrenal glands stop working properly. In 65-75% of children, growth stops completely. Children who are 9 years old are at risk.

Prolactinoma

This type affects children during puberty. Neoplasm occurs more often in girls than in boys.

This is due to the production of the female hormone prolactin, which is partly responsible for normal functioning. reproductive system. In the presence of a tumor, menstruation stops or does not begin at all.

Stomatropinoma

This species occurs in children aged 12-15 years, characterized by an accelerated growth rate. Such symptoms are hard to miss, many teenagers suffer from gigantism. In neurological terms, the tumor gives an indication of migraine-type headaches.

Diagnostics

Recognition of these diseases begins with a primary examination of a doctor, during which he performs:

• inspection skin;
• measurement pressure;
• probing lymphatic nodes.

The specialist collects information about the patient, finds out hereditary predisposition. Blood and urine tests are carried out, material is taken for the study of hormones.

Mandatory if a pituitary adenoma is suspected, a glucose-tolerant blood test for the presence of growth hormone is considered. Consultation of narrow specialists is obligatory. as one of fundamental methods Diagnosis is by CT or MRI of the brain.

Treatment

Treatment depends on the severity and type of tumor. There are surgical, medical and radiation interventions. These methods are used in combination.

Itsenko-Cushing's disease

Requires surgery in most cases. In some cases, proton therapy is indicated.

Prolactonoma

This disease is treatable with surgery or the use of dopamine agonists. The choice of method depends on the size of the tumor and the degree of its growth.

When using dopamine agonists, it is possible to reduce the size of the neoplasm in a short time, but such a result is possible only if the drug is well tolerated.

Somatotropinoma

Experts recommend neurosurgical removal of the tumor formation. Additionally, chemical therapy is used. After curing the tumor, constant monitoring by specialists is necessary in order to detect relapses.

Complications

Although pituitary adenoma has benign character, its development and growth can cause multiple complications.

Often, the tumor grows into neighboring areas of the brain, which causes tissue compression. This process affects vision, in difficult cases, atrophy of the optic nerve occurs, and blindness occurs.

When tissue is compressed, nerves are displaced, which leads to regular headaches. Numbness of some parts of the face may occur, patients feel a tingling or burning sensation.

Children with pituitary adenoma may experience speech dysfunction, reduced ability to concentrate, memory loss.

How many live with a pituitary adenoma

The prognosis for pituitary adenoma in children in most cases is positive. An important role in the cure is played by timely access to specialists, diagnosis and choice of therapy.

Relapses, which often occur after treatment, can become a problem.

Complete recovery is observed in 65% of patients, 12% are prone to recurrence.

After therapy, children begin a long stage of rehabilitation, since the activity of the body systems is completely disrupted due to chemical or radiation exposure.

Prevention

In most cases, it is impossible to avoid the disease. This is due to the fact that the causes of development are not fully understood.

With a hereditary predisposition to the disease, experts recommend parents to examine the child more often, carefully monitor the state of his health, and not start minor, at first glance, diseases.

Activities that can lead to craniocerebral injuries should be excluded, completely cured infectious diseases, prevent prolonged stressful situations in the child's life, avoid treatment with hormone-containing drugs.