– What are pituitary adenomas?
– What are the different forms of pituitary adenoma?
– Symptoms of pituitary adenomas
– Diagnosis of pituitary adenomas
– Treatment of pituitary adenomas
Pituitary adenomas are a form of brain tumor. They are benign or malignant tumors of the pituitary gland, whose symptoms vary according to their size and nature (secretory or non-secretory). Diagnosed using imaging techniques, they are treated like many cancers by surgery, radiotherapy, and chemotherapy. Medications can also relieve symptoms and limit the risk of recurrence.
What are pituitary adenomas?
Pituitary adenomas are tumors that grow from cells in the pituitary gland. The pituitary gland is an endocrine brain gland located in a small bony cavity (the pituitary fossa) situated at the skull base and protected by the Sella turcica. It is connected to another part of the brain, the hypothalamus, which partly controls its function. The pituitary gland secretes typically hormones that play essential roles in many of the body’s functions. The hormones produced by the pituitary gland control the functioning of endocrine glands throughout the body.
Good to know: Pituitary adenomas account for 10-20% of brain tumors in adults. In children, these tumors are rare. Pituitary adenomas are most often benign tumors, but some can become aggressive and invasive. The origin of pituitary adenomas remains unknown.
Pituitary adenomas contain cancer cells that are derived from normal cells of the pituitary gland. In some cases, the cancer cells may retain their ability to produce pituitary hormones. The adenomas are then said to be secreting, unlike non-secreting adenomas that do not produce pituitary hormones.
What are the different forms of pituitary adenoma?
Depending on whether or not they secrete, pituitary adenomas can give rise to 3 main types of syndromes:
– a pituitary tumor syndrome (symptoms directly associated with the presence of the tumor in the pituitary gland);
– a hormone hypersecretion syndrome in the case of secretory adenomas:
◦ hyperprolactinemia (abnormal prolactin secretion);
◦ acromegaly (abnormal secretion of growth hormone);
◦ hypercorticism or Cushing’s syndrome (abnormal secretion);
◦ hyperthyroidism (abnormal secretion of thyroid-stimulating hormone);
– a syndrome of anterior pituitary insufficiency or hypopituitarism in the case of non-secreting adenomas.
Good to know: these 3 types of the syndrome can be present simultaneously or independently. Pituitary adenomas may have different names depending on the pituitary hormone secreted (prolactinomas are adenomas that secrete prolactin).
Symptoms of Pituitary Adenomas
Pituitary adenomas can cause 3 main types of syndromes, each responsible for different symptoms.
Symptoms of the tumor
The following symptoms characterize pituitary tumor syndrome:
– visual disturbances such as visual discomfort, difficulty in fixing an object, a scotoma (blind spot in the visual field), despite usually normal visual acuity;
– more rarely, a pituitary apoplexy combining violent headaches, stiffness in the neck, paralysis of the eyes, confusion, and even coma.
Symptoms of hypersecretion syndrome
Pituitary hypersecretion syndrome manifests itself through different symptoms depending on the pituitary hormone(s) secreted in excess by the cancer cells:
– Hyperprolactinemia leading to a long-term risk of osteoporosis and other signs according to gender:
◦ In women, galactorrhea (secretion of breast milk outside the context of childbirth), amenorrhea or dysmenorrhea (cessation or disruption of menstrual cycles), and dyspareunia (change in libido).
◦ In men, galactorrhea, gynecomastia (abnormal breast development), or sexual disorders.
– An acromegaly that causes several symptoms and risks of complications:
◦ Symptoms such as deformations of the extremities of the limbs or even the rest of the skeleton, a characteristic face, night sweats, headaches, joint and tendon pain, severe fatigue, snoring, and high blood pressure (50% of cases).
◦ Risk of complications such as heart problems, joint malformations, diabetes or glucose intolerance, sleep apnea syndrome, thyroid goiters, and colon polyps.
– Hypercorticism or Cushing’s syndrome marked by various signs such as muscle atrophy, skin atrophy with difficult healing, stretch marks, sensitive and eruptive skin, localized weight gain (face, trunk, buffalo hump), mental disorders, often moderate high blood pressure, and osteoporosis.
Symptoms of Hypopituitarism
Hypopituitarism is not a specific pituitary adenoma syndrome. However, it accompanies non-secreting adenomas and is manifested by various symptoms:
– skin disorders (facial paleness, depigmentation of certain areas, depilation of the armpits and pubis);
– Sexual disorders (decreased libido or impotence, disturbance of menstrual cycles in women);
– bone demineralization or even osteoporosis;
– severe fatigue;
– a tendency to low blood pressure;
– weight loss associated with decreased appetite and hypoglycemia;
– reduced muscle mass and strength;
– stunted growth in children.
Diagnosis of pituitary adenomas
The diagnosis of pituitary adenomas is sought when the patient presents symptoms suggestive of a pituitary disorder. To confirm the diagnosis, characterize the tumor, and evaluate its consequences on the patient’s health, various tests are essential:
– a brain scan, often replaced by a cerebral MRI;
– Ultrasound scans (abdominal region, kidneys, thyroid);
– blood tests to measure pituitary hormones and the secretion of hormones by the pituitary gland;
– a complete ophthalmological check-up (fundus, the study of the visual field);
– a cardiological check-up (blood pressure measurement, electrocardiogram);
– a colonoscopy (examination of the colon);
– a rheumatological check-up.
According to the size of the pituitary adenoma, specialists distinguish 2 categories of adenomas:
– microadenomas measuring less than 1 cm in diameter;
– macro-adenomas, which measure more than 1 cm in diameter.
Treatment of pituitary adenomas
The treatment of pituitary adenomas requires surgery to remove the tumor. This procedure performed under general anesthesia is complex. One of the main risks of this operation is the occurrence of lesions of the pituitary gland, leading to hypopituitarism. Despite the surgery, there is still a risk of recurrence of the adenoma. Before the surgery, certain medications may help to reduce the excessive secretion of certain pituitary hormones. These drug treatments can also contribute to the success of the surgery. They can be continued after the surgery to limit the risk of recurrence.
Good to know: In some cases, localized radiotherapy may be prescribed, as well as appropriate chemotherapy.
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