Your pituitary gland can develop benign tumors called Pituitary Adenomas. Despite not being malignant, they can disrupt the pituitary's regular operation and lead to certain medical disorders.
The Pituitary Adenoma
Your pituitary gland can develop benign tumors called Pituitary Adenomas. Despite not being malignant, they can disrupt the pituitary's regular operation and lead to certain medical disorders.
A Pituitary Adenoma: What is It?
A benign (noncancerous) development on your pituitary gland is referred to as a Pituitary Adenoma. It doesn't spread to other sections of your body as cancer does.
The Pituitary Gland is What?
A tiny gland the size of a pea, your pituitary is connected to your hypothalamus, the base of your brain, just below your nose. The front lobe and the posterior lobe are two lobes.
Several significant hormones are released by your pituitary gland including:
- Hormone adrenocorticotropic (ACTH or corticotropin).
- Antidiuretic steroid (ADH, or vasopressin).
- The hormone that stimulates ovulation (FSH).
- Growth Hormone (GH).
- Vitamin D hormone (LH).
- Oxytocin.
- Prolactin.
- The hormone that stimulates the thyroid (TSH).
The synthesis and release of a single hormone or a group of hormones can be impacted by pituitary adenomas, it should be noted.
Pituitary adenomas are categorized by medical professionals according to whether or not they produce additional hormones.
- Adenomas that are functioning (secreting): Depending on the hormones they release, these adenomas cause different symptoms and/or disorders.
- Non-secreting (non-functioning) adenomas: If they enlarge, these adenomas can squeeze surrounding structures even if they don't release hormones. Pituitary adenomas that do not function are the most frequent adenomas that doctors diagnose.
Pituitary adenomas are also categorized by size by healthcare professionals:
- Adenomas that are smaller than 10 millimeters or 1 centimeter are known as microadenomas.
- Adenomas that are greater than 10 millimeters in size are known as macroadenomas. When compared to microadenomas, macroadenomas are twice as prevalent.
Additionally, they are more likely to result in pituitary hormone levels that are lower than usual. The term for this is hypopituitarism.
Is a Brain Tumour a Pituitary Adenoma?
Although your pituitary gland is an endocrine structure that is technically not a part of your brain but is connected to it, medical professionals still refer to pituitary adenomas as brain tumors.
Who is Affected by Pituitary Adenomas?
Though they can develop at any age, pituitary adenomas are more frequent in persons in their 30s and 40s. Pituitary adenomas are more common in women and those who were allocated female at birth (AFAB) than in males and those who were (AMAB).
How Frequently Do Pituitary Adenomas Occur?
10% to 15% of the tumors that form inside your skull are pituitary adenomas.
What Signs Might Point to a Pituitary Adenoma?
Pituitary adenomas can cause a wide range of symptoms based on several variables, such as:
- If it is substantial enough to harm your pituitary gland or other adjacent structures (mass effect).
- If the pituitary adenoma is active (secreting hormones), the symptoms will depend on the hormones it secretes.
Pituitary macroadenomas frequently have mass consequences, which means that their size can put pressure on or harm adjacent tissues, leading to compressive symptoms like:
- Vision issues: As a result of the adenoma, between 40% to 60% of persons with a pituitary macroadenoma have impaired eyesight (double or hazy vision). Your optic chiasm is compressed by the adenoma, resulting in visual field abnormalities like loss of peripheral vision. (side vision).
- Headaches: Headaches are frequently reported by those who have pituitary adenomas. Although pressure on neighboring tissues may be to blame, as headaches are a frequent ailment in general, there may be other causes as well.
- Hormone shortage: Pituitary macroadenomas can harm the tissue of your pituitary gland, which can result in one or more pituitary hormone deficits. Hypopituitarism, often known as an underactive pituitary gland, may occur from this.
The symptoms of each pituitary hormone deficit vary.
- Hypogonadism, a condition marked by low levels of both testosterone and estrogen, is brought on by a lack of the hormones LH and FSH. Hot flashes and dry vaginal lining are two signs of hypogonadism in both women and men. Men and people with AFAB, erectile dysfunction, reduced facial and body hair growth AMAB, irritability, decreased libido, and sex drive.
- Hypothyroidism, a condition marked by inadequate thyroid hormone production, is brought on by a TSH shortage. Fatigue, constipation, a slow heartbeat, dry skin, swelling of the extremities, and weakened reflexes are all signs of hypothyroidism.
- Adrenal insufficiency, caused by a lack of ACTH, results in lower cortisol production. Low blood pressure, nausea, vomiting, abdominal pain, and poor appetite are all signs of adrenal insufficiency.
- Low growth hormone production, or growth hormone deficit, is a symptom of GH insufficiency. Depending on your age, you'll experience a variety of symptoms. Adults who don't get enough GH get tired and have less muscle mass.
What Signs and Symptoms are Produced by Active Pituitary Adenomas?
An active or secreting pituitary adenoma discharges too much hormone. Depending on the pituitary hormone they release functioning pituitary adenomas can result in a variety of symptoms.
Extra pituitary hormones from a functional adenoma can cause the following issues since your body regularly controls hormone levels for optimum health:
- Prolactinomas (lactotroph adenomas): Hyperprolactinemia, a disorder caused by prolactinomas (lactotroph adenomas) is the overproduction of prolactin. About 4 out of 10 pituitary tumors are prolactinomas. They are the form of pituitary adenoma that is most prevalent.
By interfering with the hormones made by your testicles or ovaries, high prolactin levels can interfere with normal reproductive processes. These signs include:
- Infertility in both men and women.
- When not pregnant, milky discharge from your nipples is referred to as (galactorrhea).
- Angiotrophic adenomas: Somatotroph adenomas, also known as somatotropin-producing tumors, account for around 2 in 10 pituitary tumors and produce too much growth hormone.
Depending on your age, somatotroph adenomas might manifest with a variety of symptoms.
Acromegaly, a rare but serious condition caused by too much growth hormone, affects your body's bones and tissues and causes them to grow abnormally. Over time, it can result in enlarged hands, feet, or head size, as well as a rounded face with poorly defined features. It can also affect critical metabolic processes like blood sugar (glucose) regulation and increase the size of your heart muscle. These adenomas are a common cause of acromegaly in adults.
Somatotroph adenomas, also known as pediatric acromegaly and pituitary gigantism, are the source of gigantism in children and adolescents, which is characterized by high quantities of growth hormone in the body. become quite tall.
- Adenomas with corticotroph: Extra adrenocorticotropic hormone is produced by corticotroph adenomas. (ACTH). About 1 in 10 pituitary tumors are caused by them. Your adrenal glands are stimulated by ACTH to produce steroid hormones, such as cortisol.
Cushing's syndrome is caused by corticotroph adenomas (excess cortisol).
Symptoms
- Elevated blood pressure.
- Muscular lassitude.
- Easy to bruise.
- Over your tummy, there are wide (> 1 centimeter), purple stretch marks.
- Osteoporosis.
- Fractures from compression.
- Diabetes mellitus type 2.
- Thyroid-related tumors: Thyrotroph adenomas are extremely rare tumors that produce too much thyroid-stimulating hormone (TSH). TSH encourages the production and release of thyroid hormone by your thyroid gland.
The disease known as hyperthyroidism, which is brought on by high levels of thyroid hormone, accelerates your metabolism. This leads to signs like:
- Quick heartbeat.
- Loss of weight without cause.
- Weak stools (poop).
- Sweating.
- Shaky hands.
- Anxiety.
Pituitary adenomas are a rare cause of hyperthyroidism, which has numerous other reasons as well.
- Gonadotrophin tumors: Luteinizing hormone (LH) and follicle-stimulating hormone, are gonadotropins that are produced in excess by gonadotroph adenomas. (FSH). Rarely do gonadotroph adenomas occur.
Women and people with AFAB who have these adenomas may experience irregular periods and ovarian hyperstimulation syndrome (OHSS). A deeper voice, balding around the temples, larger testicles, and rapid facial hair development are among the symptoms of AMAB in men.
Children may experience precocious (early) puberty as a result of them.
Why do Pituitary Adenomas Develop?
The Pituitary adenomas precise cause is unknown to scientists.
However, certain adenomas have been connected to unintentional modifications or mutations in DNA, the cellular component that makes up our genes. Due to these modifications, the cells in your pituitary gland swell out of control and form a mass (growth).
Although the genetic modifications might be transferred from parents to offspring, they typically occur at random.
Pituitary adenomas are linked to several hereditary disorders, such as:
- Type 1 multiple endocrine neoplasias.
- Type 4 multiple endocrine neoplasias.
- Complex Carney.
- X-LAG disease.
- Pituitary adenoma in the family is connected to succinate dehydrogenase.
- Type 1 neurofibromatosis.
- Syndrome of Von Hippel-Lindau.
You can still have a pituitary adenoma even if you don't have one of these disorders, though having one of them increases your risk of developing one.
Pituitary Adenomas: How are They Identified?
The type of pituitary adenoma you have and whether it is generating symptoms will determine how to diagnose it.
Your healthcare provider will probably first identify the problem it causes, if you have a hormone-secreting pituitary adenoma, based on your symptoms. This is because disorders caused by too much hormone production can have a wide range of causes, not simply pituitary adenomas. This also applies to the reasons for hypopituitarism (lack of pituitary hormone).
Pituitary adenomas can occasionally be discovered by accident when you undergo a brain imaging examination for another condition. The adenoma in these situations is often tiny and dormant.
What Diagnostic Procedures are Used to Identify a Pituitary Adenoma?
Your doctor will do a thorough evaluation of your symptoms, medical history, and physical exam if they suspect you may have a pituitary adenoma.
Any of the following tests could be requested:
Blood tests: Your doctor may prescribe blood tests to examine certain hormone levels based on your symptoms.
Imaging tests: An MRI (magnetic resonance imaging) or CT (computed tomography) scan of your head can produce images of the internal structures. An accurate diagnosis of a pituitary adenoma can be made using these tests.
Eye exam: If you are experiencing vision issues, your doctor may have you complete a visual field test to assess the health of your eyes. Large pituitary adenomas can obstruct vision by pressing on the nerves that link your eyes to your brain.
In What Ways Is a Pituitary Adenoma Managed?
Pituitary adenomas are typically treated by medical professionals using surgery, medication, radiation therapy, or a combination of these treatments. Each pituitary adenoma is unique, therefore you will develop a treatment strategy with the help of your medical team that is most effective for you.
Removal of Pituitary Adenomas with surgery
Your doctor would probably advise surgery to remove all or part of the pituitary adenoma if it's producing a hormonal imbalance in you. You might require several operations, depending on the extent of the adenoma and the seriousness of your symptoms.
To remove the pituitary adenoma, your surgeon will probably undertake a procedure known as transsphenoidal surgery, which entails entering your skull through your nose and sphenoid sinus, a hollow area behind your nasal passages and beneath your brain, to perform surgery. 95% of pituitary tumors are treated by surgery using this method.
Your surgeon may perform transcranial surgery to open your skull to access your pituitary and the adenoma if it is too large to be removed through your sinus cavity. This method of treating pituitary adenomas is uncommon.
Prescription drugs for Pituitary Adenomas
Some types of pituitary adenomas can be treated by medical professionals using drugs that decrease the adenoma and reduce symptoms.
A dopamine agonists therapy drug, such as cabergoline (Dostinex®) or bromocriptine (Cycloset®), will probably be prescribed to you if you have a prolactinoma (the most typical type of pituitary adenoma).
These drugs reduce prolactinoma in 80% of cases, allowing prolactin levels to return to normal. If the drug is ineffective, your doctor might advise surgery.
Treatment with radiation for Pituitary Adenomas
Adenomas or tumors can be reduced using radiation therapy by using high-energy X-rays. For pituitary adenomas, medical professionals employ stereotactic radiosurgery, a specialized form of radiation therapy that uses a high dosage of radiation precisely targeted at the adenoma from multiple directions to prevent the adenoma from expanding.
What Negative Effects Might the Treatment for Pituitary Adenoma Cause?
Approximately 60% of patients with pituitary adenomas go on to acquire hypopituitarism, a condition in which one, many, or all of your pituitary hormones aren't produced as a result of operations and/or radiation treatments. The condition of hypopituitarism can be managed with hormone replacement therapy.
The following are possible side effects from surgery to remove a pituitary adenoma:
- Bleeding.
- The CSF (cerebrospinal fluid) leaks.
- Meningitis.
- Diabetes insipidus is a disorder that causes the posterior pituitary gland to completely or partially stop producing antidiuretic hormone. This disorder makes you urinate a lot of diluted urine, which results in an excess of sodium (salt) in your body.
Dopamine agonists frequently used by doctors to treat prolactinomas cause headaches, nausea, vomiting, dizziness, and occasionally an increase in obsessive behavior.
The following are possible radiation therapy negative effects:
- Lack of pituitary hormones.
- Insufficient fertility.
- Loss of vision and brain damage (rare).
- Few years following treatment, tumor growth (rare).
To sum up, pituitary adenoma is a disorder that can be efficiently treated with a mix of medicinal and surgical procedures. Working together with your medical team will help you create a treatment plan that is tailored to your specific requirements and will help you achieve the greatest results.
