Pituitary adenoma

"Throughout these more than 15 years we have been developing endoscopic nasal surgery to make it safer and to achieve a higher rate of complete tumor resections".

DR. BARTOLOMÉ BEJARANO
SPECIALIST. BRAIN TUMOUR AREA

Pituitary adenoma is a benign tumor.  The pituitary is a small gland located in the Turkish saddle, which is a bony depression at the base of the skull that produces a large amount of hormones, responsible for controlling many body functions, hence it is called the "master" gland.

From this pituitary gland, pituitary adenomas can be formed, which are relatively common (1 to 8 cases per 100,000 inhabitants) and constitute 10-15% of all intracranial tumors, having their maximum incidence in the 3rd and 4th decades of life.

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What are the symptoms of pituitary adenoma?

Functioning or functional tumors cause disease especially by the excess of the hormone they secrete into the bloodstream.

  • The most common are prolactinomas or prolactin producers, which produce absence or irregularity of menstruation in women, decreased libido in men and infertility and milk production (galactorrhea) in men and women. Most of these adenomas are treated pharmacologically by endocrinologists.
  • In contrast, there are other functioning tumors such as GH (growth hormone) producers that cause acromegaly (adults) or gigantism (children) and ACTH producers that develop Cushing's disease from excess cortisol (stress hormone). Its main treatment is surgery.

Unlike the previous ones, non-functional tumors do not produce hormones, so they go unnoticed until they are a certain size, causing hormonal deficits by compression of the normal pituitary gland.

In addition, if the adenoma progresses and grows excessively, it can come out of the saddle, compressing neighboring structures, such as the optical pathways, and can cause progressive visual loss (in some cases it can be abrupt due to bleeding from the tumor).

Do you have any of these symptoms?

You may have a pituitary adenoma

What are the causes of pituitary adenoma?

For the vast majority of pituitary adenomas, we do not yet know the cause, although research continues in this field.

Only a genetic predisposition is known with certainty in what we call Multiple Endocrine Neoplasia Syndrome Type 1 (MEN-1), linked to an alteration of chromosome number 11. But only 3% of pituitary adenomas occur in the context of these multiple endocrine tumors.

How is pituitary adenoma diagnosed?

It is common for pituitary adenomas to be detected by chance when performing a brain MRI for another reason. The MRI allows to evaluate the type, size and relationship of the tumor with the neighboring structures.

It will be necessary to carry out a blood analysis with hormonal detection to know which hormones are being hyperproduced.

The diagnosis is completed with an ophthalmological examination to assess whether the adenoma may be causing compression of the optic chiasm.

What types are there?

Depending on the size:

  • Microadenomas (less than 1 cm)
  • Macroadenomas (greater than 1 cm)

Between 70 and 90% of patients with a pituitary macroadenoma have deficits in one or more pituitary hormones at the time of diagnosis, while the percentage is lower in microadenomas

Depending on whether they secrete hormones themselves or not:

  • Functioning (secreting). They account for one third of pituitary adenomas. 30% are prolactinomas (produce prolactin), 20% are producers of GH, 15% of ACTH and 1% of TSH.
  • Non-functioning (non-secreting).

How is pituitary adenoma treated?

Surgery is the most common treatment for pituitary adenomas

Although the treatment of choice is surgery, a combination of different types of treatment is common.

Current treatment options include:

  • Pharmacological and hormone replacement therapy
  • Surgery (microsurgical or endoscopic transsphenoidal and transcranial)
  • Radiotherapy/radiosurgery

Medications that block hormone secretion can control symptoms and sometimes reduce the size of the tumor, especially in prolactinomas.

If the pituitary gland were damaged during surgery, the patient would subsequently require treatment to replace the deficient hormones (cortisol, GH, thyroid hormone, estrogens, testosterone, antidiuretic hormone). 

Today, the great development of endoscopy makes possible the removal of most of these tumors through the nasal cavity, being very exceptional the need for a craniotomy (opening of the skull).

In addition, the collaboration of the neurosurgeon with the otolaryngologist allows the execution of procedures that are less and less cruel and more complex under modern systems of lenses, cameras and high definition monitors.

Endoscopic nasal surgery consists of introducing an endoscope through the nostrils, which slides between the middle turbinate and the nasal septum, until the sphenoid hole is located. This hole is enlarged to achieve a sufficient opening of the sphenoidal sinus, allowing the floor of the Turkish saddle to be visualized for the removal of the tumor.

Unlike the conventional microscopic technique, there is usually no nasal packing left.

After the operation, the patient goes to the ICU and, the next day, to the ward, where he is assessed by Neurosurgery, Otolaryngology and Endocrinology.

As for the hospital stay after surgery, in uncomplicated cases 3-4 days are sufficient. However, sometimes, due to the hormonal pituitary pathology itself (especially in Cushing's disease), the endocrinologist has to perform several analytical studies and adjust the medication, so the stay can be extended a few days more.

Where do we treat it?

IN NAVARRE AND MADRID

OUR MEDICAL TEAM
Brain Tumor Specialists

In the Brain Tumor Area we offer maximum safety and efficiency in brain tumor surgery, being the first hospital with a high field magnetic resonance within the operating room.

We have a highly specialized team in the surgery of brain tumors, with more than 15 years of experience.

The individualized treatment of each case by an interdisciplinary team allows us to offer the best alternative to each patient.

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