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Pituitary Adenoma

Pituitary Adenoma

Introduction

The abnormal growth that occurs in the pituitary gland are classified as pituitary adenoma. Some of these pituitary adenomas can lead to the secretion of too many hormones that regulate important functions of our body while some of the pituitary adenomas can cause lower levels of hormone secretion by the pituitary gland.

Most pituitary adenomas are benign (noncancerous) adenoma (growths). Adenomas do not spread to other parts of the body it remains in your pituitary gland and other surrounding tissues.

Pituitary adenoma

Symptoms of pituitary adenoma

All the pituitary adenomas are not symptom causing, pituitary adenoma that produces hormones (functioning) may cause a variety of signs and symptoms that depends on the hormone produced by them. The symptoms and signs of pituitary adenoma that do not make a hormone (nonfunctioning) are related to their growth and pressure they apply to the structures.

Those pituitary adenoma measures around 1 centimeter or the larger area known as macroadenomas (large pituitary adenoma), and small pituitary adenoma are called as microadenomas. Macroadenomas can put pressure on the normal pituitary and surrounding structures because of their large size.

Sign and symptoms related to tumor pressure of the pituitary gland include:

  • Headache
  • Vision loss, particularly loss of peripheral vision


Symptoms related to hormone level changes

  • Over functioning: Overproduction of hormones can be caused by functioning pituitary adenoma. Different types of tumors present in the pituitary gland can cause signs and symptoms and sometimes a combination of these symptoms.   
  • Deficiency: Larger tumors can cause hormonal deficiencies. These sign and symptoms include:
  • Nausea & vomiting
  • Weakness
  • Feeling cold
  • Less frequent or no menstrual periods
  • Sexual dysfunction
  • An increased amount of urine
  • Unintended weight loss or gain
  • Adrenocorticotropic hormone-secreting (ACTH) tumors


The hormone adrenocorticotropin is produced by ACTH tumors, that stimulates the adrenal glands to make the hormone cortisol. Crushing’s syndrome results from the adrenal glands producing too much cortisol. Sign and symptoms of Crushing’s syndrome include:

  • Fat accumulation around your midsection and upper back
  • Exaggerated facial roundness
  • Thinning of the arms and legs along with weak muscles weakness
  • High blood pressure
  • High blood sugar
  • Acne bone weakening
  • Bruising
  • Stretch marks
  • Anxiety or depression
  • Growth hormone-secreting tumors


Their tumors are responsible for producing growth hormone in excess amount, which may cause:

  • Coarsened facial features
  • Enlarged hands and feet
  • Excess sweating
  • High blood sugar
  • Heart problems
  • Joint pain
  • Misaligned teeth
  • Increased body hair


Prolactin secreting tumors:

Overproduction of prolactin from the pituitary adenoma (prolactinoma) may cause a decrease in the usual amount of sex hormones (estrogen in females and progesterone in males). Excess prolactin in blood has affected males and females differently.

In males, a prolactin producing tumor can cause male hypogonadism. Signs and symptoms include:

  • Erectile dysfunction
  • Low sperm count
  • Loss of sex drive
  • Breast growth
  • Thyroid-stimulating hormone-secreting tumors


When a pituitary adenoma overproduces TSH (Thyroid-stimulating hormone), the thyroid gland secretes too much of the hormone thyroxine. That is a rare cause of hyperthyroidism or overactive thyroid disease. Hypothyroidism can accelerate body metabolism, and cause:

  • Weight loss
  • Rapid or irregular heartbeat
  • Nervousness or irritability
  • Frequent bowel movements
  • Excessive sweating

Causes and Risk Factor

Causes of pituitary adenoma

The cause of the uncontrolled growth of cells in the pituitary gland, which creates a tumor, remains unknown.

The pituitary gland is a small, pea-sized gland present at the base of the brain, rather behind the nose and between the ears. Despite its small size, the gland impacts almost every part of the body. The hormones secreted by the pituitary gland helps to regulate functions, such as growth, blood pressure, and reproduction.

A little level of pituitary adenoma cases run in families; however, most have no clear heredity factor. All things considered; researchers presume that hereditary modifications assume a significant part of how pituitary adenoma creates.

Risk factors for pituitary adenoma

People with a family history of determined heredity conditions, such as multiple endocrine neoplasias, type 1 (MEN 1), have a greater risk of developing pituitary adenoma. Multiple tumors occur in various glands of the endocrine system in MEN 1.

Diagnosis for pituitary adenoma

Your doctor will take your medical history and may perform a physical examination. They might order you some tests including:

Blood and urine test- These tests help to determine the overproduction and deficiency of hormones.

Brain imaging- A CT scan or MRI scan of the brain helps to see the location and size of the pituitary adenoma.

Vision testing: This may determine if a pituitary adenoma has impaired your sight or peripheral vision.

Treatment for pituitary adenoma

Not all pituitary adenoma requires any treatment, but those that need treatment depends on the type, size of the tumor, and how far it spread into the brain.

Treatment includes a group of medical experts, possibly involving a neuro surgeon, endocrinologist, and a radiation oncologist. Doctors usually use medications, radiation therapy, and surgery, either alone or in combination, to treat a pituitary adenoma and get back the production of hormones to normal levels.

Surgery

This process includes the removal of the pituitary adenoma this can be done in the case where the tumor is pressing the optic nerves or if the tumor is overproducing certain hormones. There are two main techniques for surgical removal of a pituitary adenoma include:

Endoscopic transnasal transsphenoidal approach- In this procedure your doctor usually removes the tumor through your nose and sinuses without an external incision, and it doesn’t impact other parts of the brain and leaves no visible scar. But for large tumors, this procedure may be difficult especially if a tumor has invaded nearby nerves and brain tissues.

Transcranial approach (craniotomy): In this procedure, the tumor is removed from the upper part of the skull via an incision in the scalp. Through this procedure, it is easy to remove large tumors.

Radiation therapy:

Radiation therapy includes the removal of tumors by using high energy sources of radiation. In case a tumor persists or return after the surgery and cause symptoms that medications don’t relieve, radiation therapy can be useful. If can be done alone or after the surgery.

Radiation therapy methods include:

  • Stereotactic radiosurgery
  • External beam radiation
  • Intensity-modulated radiation therapy (IMRT)
  • Proton beam therapy


Medications

Medications may help to block excess hormone secretion and sometimes shrinks the certain type of tumors.

Complications

Usually, pituitary adenoma doesn’t spread or grow extensively. But they may have an impact on the health of the individual, possibly causing:

Vision loss- Cause because the pressure is put by the put by the pituitary adenoma on the optic nerves.

Permanent hormone deficiency- The pituitary adenoma’s presence or the removal of one can permanently alter the hormone supply, which is important to be replaced by hormone medications.

Pituitary apoplexy- This is a rare but potentially serious complication of a pituitary adenoma. It happens when sudden bleeding into the tumor occurs. It may be felt like a severe headache. This condition requires emergency treatment, usually with corticosteroids and possible surgery.

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