Pituitary tumors are one of the medical conditions that attract the attention of doctors and researchers a lot, due to their direct impact on the balance of hormones in the body, in addition to their role in regulating many vital processes. The pituitary gland, sometimes called the hormonal “maestro,” is located at the base of the brain near its center, and is one of the most important endocrine glands as it secretes hormones that affect many organs and vital functions such as growth and metabolism.
The types of pituitary tumors vary greatly and differ in size, the type of hormone they secrete, and the symptoms associated with them, which makes early diagnosis and effective treatment of great importance. With scientific and technical progress, diagnostic and treatment methods have evolved, and options have become more diverse and effective.
What are pituitary tumors?
Pituitary tumors are abnormal growths that occur in the cells of the pituitary gland, most often adenoma, which is a benign type of tumors, meaning it is not cancerous and does not spread to other parts of the body, but its size and impact can cause serious complications, as these tumors can cause an increase or decrease the secretion of hormones, which leads to the appearance of various symptoms that affect the patient’s overall health.
Pituitary tumors vary greatly in size, as they can be very small (under the microscope) or very large, known as gigantomas, and are one of the most common causes of hormone disorders in adults.
Types of pituitary tumors
The types of pituitary tumors vary based on the type of hormone they secrete or whether or not they secrete any hormone, and can be classified into many types of tumors, including three types.
Tumors that secrete hormones
- Prolactinoma: The most common type of pituitary tumor that secretes the hormone prolactin, causing menstrual irregularities, abnormal milk secretion, and low libido.
- Growth hormone tumors: These tumors increase the release of growth hormone and cause Graves’ disease or acromegaly.
- Tumors that secrete cortisol: Lead to Cushing’s syndrome, which is characterized by weight gain, high blood pressure, and muscle weakness.
- Tumors that secrete other hormones: Such as thyroid or adrenal hormones.
Tumors that don’t secrete hormones
- Often benign
- Tumor pressure symptoms, such as headaches and vision disturbances, often appear before they are detected
Large or invasive tumors
- They are large and compress neighboring tissues, causing more severe symptoms
Detecting pituitary tumors
To detect and diagnose a pituitary tumor, your doctor will likely talk to you about your personal and family medical history and perform a physical exam. Tests to detect a pituitary tumor may also include the following:
- Blood tests: Blood tests can show whether your body has too much or too little of certain hormones.
- Urine tests: A urine test can be used to help diagnose a pituitary adenoma that produces too much ACTH. Too much ACTH leads to increased cortisol in the body and causes Cushing’s disease.
- Magnetic Resonance Imaging (MRI): A brain MRI can help detect a pituitary tumor and show its location and size.
- Computerized tomography (CT) scan: A CT scan is helpful in planning for surgery if the doctor tells the patient that a pituitary tumor needs to be removed.
- Vision test: A pituitary tumor can affect vision, especially side vision, also called peripheral vision. An eye test may help to check how well the patient can see.
Causes of pituitary tumors
To date, the exact causes of pituitary tumors are not fully known, but several factors are thought to play a role in their development, including:
- Genetic factors: Certain rare genetic conditions, such as Multiple Endocrine Neoplasia (MEN) syndrome, increase the likelihood of pituitary tumors, and gene mutations that affect cell growth and proliferation.
- Environmental factors: Exposure to radiation or carcinogens may increase the risk of pituitary tumors, especially if the exposure is excessive or continuous.
- Hormone imbalances: Some conditions that lead to hormonal imbalances may be associated with pituitary tumors, but the relationship is not always direct.
- Aging, as the likelihood of tumors increases with age
- Previous cases of endocrine disorders or other tumors
Symptoms of pituitary tumors
Symptoms of pituitary tumors vary greatly depending on the type, size, and location of the tumor, as well as the hormones it produces. Here are some of the most common symptoms:
Symptoms caused by hormone disorders
- Increase the hormone cortisol: Leads to Cushing’s syndrome, which is characterized by weight gain, high blood pressure, and muscle weakness.
- Excessive secretion of the hormone prolactin: Causes low libido, irregular menstrual cycles, or milk production unrelated to lactation.
- Increased growth hormone: Leads to enlarged limbs, changes in facial features, and joint pain.
- Disorders of thyroid function: Under- or overproduction of thyroid hormones.
Symptoms caused by the tumor’s pressure on surrounding tissues
- Problems with vision: Especially visual field loss or poor vision, due to the tumor’s pressure on the optic nerve.
- Constant headaches: Often in the head area, increasing as the tumor grows.
- Problems with balance and dizziness
Other symptoms
- General fatigue and exhaustion
- Sleep disturbances
- Mood disorders such as depression or anxiety
Pituitary tumor treatment
The pituitary tumors treatment is one of the most important challenges facing modern medicine, as most cases require a clear and accurate assessment and an integrated treatment plan to ensure the best possible results for the patient, and with technological advances and continuous scientific research, treatment options have become more diverse and effective, which contributes to improving recovery rates and reducing complications.
The choice of appropriate treatment depends on several factors, including the size, location and type of the tumor, the patient’s general health status, as well as the accompanying symptoms Whether the treatment is surgical, pharmacological, radiation or targeted, the main goal is to control growth, reduce symptoms and prevent the spread of the disease, and in this context, early and accurate diagnosis plays a crucial role in improving the chances of treatment and achieving positive results in the long term.
Pituitary tumors treatment with surgery
Surgery is the main treatment for many pituitary tumors, as how surgery is performed and how successful it is depends on several factors including the type of tumor and whether it has spread to nearby tissues, there are many ways to remove pituitary tumors with surgery where the difference lies in the method to reach the tumor.
Transsphenoidal surgery
This is the most common way to remove pituitary tumors. The surgeon first makes a small cut inside the nose, then opens the bony walls of the sphenoid sinus with small surgical instruments. Other small instruments are then passed through the opening to reach the pituitary gland to remove the tumor.
The surgeon can look at the tumor and nearby tissues using an endoscope, which is a thin fiber-optic tube with a small video camera at its tip. No part of the brain is touched during wedge surgery, so the chance of brain damage is very low. When this surgery is performed by an experienced neurosurgeon and the tumor is small, the chances of complete removal are high
Craniotomy
If the pituitary tumor is larger or more complex, a craniotomy may be needed. This surgery is done through an opening in the front of the skull on one side, then the surgeon must carefully incise under and between the lobes of the brain to reach the tumor.
Craniotomy has a greater chance of brain injury and other side effects compared with transsphenoidal surgery for small tumors, but is safer for large, complex tumors because the surgeon is better able to see and access the tumor as well as nearby nerves and blood vessels.
Treating pituitary tumors with radiation
If part of the pituitary tumor cannot be removed during surgery and medications cannot control symptoms, doctors may use radiation therapy by shining a single high dose of energy to destroy the patient’s cancer cells over several treatment sessions, as there are many types of radiation treatments aimed at removing pituitary tumors surgically.
Gamma Knife Surgery
Gamma knife surgery is a technique that uses precisely focused radiation to treat small pituitary tumors or portions of tumors that are not completely removed after surgery
It relies on directing multiple, highly precise, targeted radiation beams to the tumor in a single session, while protecting nearby vital tissues from excess radiation. During the procedure, the patient is immobilized by a head frame to ensure immobility, allowing for highly precise targeting. This surgery is considered a non-invasive outpatient treatment and usually takes only a few hours
Stereotactic radiotherapy
Stereotactic radiation therapy uses a linear accelerator, a device that rotates around you during treatment. It delivers radiation from different directions while minimizing the dose to nearby healthy tissue. Doctors deliver multiple doses of radiation to the pituitary tumor over several weeks, rather than a single treatment session. This is chosen for more extensive tumors. Treatments are done on an outpatient basis
External Beam Radiotherapy
Doctors may use external beam radiation therapy for large pituitary tumors or large portions of the tumor that remain after surgery. A linear accelerator delivers the external radiation dose to the tumor, and doctors use treatment planning software that includes magnetic resonance imaging (MRI) or computed tomography (CT) X-rays that create 3-D and cross-sectional images of the tumor to precisely target the tumor.
External beam radiation therapy treatments are broken down into small doses that are typically given once a day, five days a week, for several weeks. Breaking down treatments into small doses enables the doctor to deliver enough radiation to effectively destroy the tumor while minimizing the risk of side effects.
Pituitary tumors treatment with medications
If medications are needed to treat the pituitary tumor, to help control hormones after surgery or radiation therapy, or to replace any missing hormones, the patient will take them at home. Medications used to treat pituitary tumors include the following:
Bromocriptine and cabergoline are used to treat pituitary tumors called prolactinomas, which produce too much of the hormone prolactin. These drugs can treat prolactinomas by reducing prolactin secretion and often shrink the tumor.
Somatostatin analogs such as Lanreotide or Octreotide for pituitary tumors that produce excess growth hormone. Somatostatin analog drugs reduce growth hormone production and may reduce tumor size. These medications can also be used to treat pituitary tumors that produce excess thyroid hormone. Pegvisomant (Somavert) blocks the effect of excess growth hormone on the body.
Ketoconazole (Nizoral) is used to treat pituitary tumors that cause facial roundness, shoulder hump, or other symptoms characterized by the body producing too much cortisol, a natural steroid hormone. This medication reduces the release of cortisol but does not shrink the tumor or stop the production of the hormone.
Prevention and early detection of pituitary tumors
Prevention and early detection of pituitary tumors requires a continuous effort from the community and doctors. Awareness of the symptoms of hormone disorders, such as persistent headaches, vision disorders, and changes in the menstrual cycle, must be increased, especially for people who are genetically predisposed or suffer from chronic hormonal diseases.
Regular hormone tests and MRI scans are recommended to detect any small tumors in the early stages, before they develop and cause serious complications, and the use of modern technologies, such as digital hormone analysis and advanced imaging, facilitates early diagnosis and increases the accuracy of the results In addition, adopting a healthy lifestyle and reducing exposure to causative factors, enhances prevention.
Continuous awareness and health education are essential to reduce the risks of the disease and improve the chances of early treatment, which contributes to minimizing complications and achieving better treatment outcomes
Finally, pituitary tumors are a condition that requires careful evaluation and early treatment to preserve the patient’s health and improve their quality of life. With advances in diagnostic and treatment techniques, treatment outcomes have become more effective, and most types of tumors can be successfully controlled. If you notice symptoms related to hormonal imbalances or vision issues, it is advisable to see your doctor for the necessary tests and timely treatment
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