Pituitary gland tumour guide
What is a pituitary gland tumour?
The pituitary gland is a tiny, pea-sized organ located behind the bridge of the nose and next to the brain. It is an organ of the endocrine system responsible for regulating levels of hormones in the body. The gland is also called the "master endocrine gland" because it secretes hormones that control other glands in the body and influence many body functions.
A pituitary gland tumour is an abnormal enlargement of pituitary cells. Because of the disease, the gland produces too little or too much hormone, causing many endocrine problems in the body.
The main types of tumours are as follows:
- Nonfunctional adenomas (null cell adenomas) are the most common type. When the neoplasm reaches a specific size, it can cause headaches and vision problems. An enlarged pituitary gland tumour destroys normal pituitary cells and leads to symptoms caused by decreased hormone production.
- Prolactin-producing tumours (prolactinomas) are the second most common benign neoplasm. A high level of prolactin in women causes irregular menstruation and breast milk production (even in the absence of pregnancy and breastfeeding). In men, the tumour provokes erectile dysfunction and sexual dysfunction. Over time, persistent headaches and vision problems might appear.
- ACTH - producing tumours - stimulates the adrenal glands to produce steroids, which affects metabolism. As a result, this condition causes fat accumulation on the face, neck, back, abdomen and chest, but the arms and legs tend to become thin. In addition, purple stretch marks, high blood pressure, and bone weakness may be seen.
- Growth hormone-producing tumours - the result of this disorder is gigantism. It includes increased height (over 7 feet), rapid growth, joint pain, and profuse sweating.
Most pituitary growths do not cause symptoms. As a result, they are not diagnosed in the early stages and usually are found during a brain scan. About 25% of people may have small pituitary tumours without knowing it.
Because the pituitary gland is next to the brain, this tumour is sometimes classified as a "brain neoplasm." The formation of the pituitary gland accounts for about 17% of all primary brain tumours. However, very few tumours will be malignant.
Most often, the disease is diagnosed in older people, but it can also occur at any age. When analyzing brain formation at the age of 15 to 19, 33% will be the probability of pituitary gland neoplasm. By gender, women are more likely to develop these tumours than men.
Symptoms depend on the damaged area of the pituitary gland and may vary from person to person. In addition, the signs of the disease may also look like other health problems. They include:
- Vision loss;
- Hair loss;
- Women have less or no menstruation or breast milk;
- In men, facial hair loss, breast tissue growth and impotence;
- In women and men, a decrease in sexual desire;
- Children have slow growth and sexual development.
There are a large number of tests to diagnose a pituitary tumour. In addition to visual examination, the following methods can be used.
- The neurological examination evaluates the central nervous system, including checking the person's reflexes, motor and sensory skills, balance and coordination, and mental status.
- Laboratory tests included hormonal tests. These tests may need to be repeated to understand how hormones are produced over time and confirm that hormone levels are consistently abnormal. In addition, saliva samples and one or more daily urine samples may be taken.
- Magnetic resonance imaging (MRI scan), with the help of magnetic fields, provides detailed body images. It is used to measure the tumour's size. Before scanning, a special dye (gadolinium) is injected to produce a sharper image.
- Computed tomography (CT scan) - takes pictures inside the body using x-rays taken from different angles. Right after, the computer combines these images into a detailed 3D image showing abnormalities or tumours. Sometimes a special dye (a contrast agent) is injected before scanning to provide better image detail.
- Examination of the visual field - the optic nerves pass over the pituitary gland, and its increase can pressure nearby nerves. During the investigation, each eye is tested separately to detect light points. The most common visual field problem caused by a pituitary tumour is the loss of the capability to see objects at the edge of a person's field of vision.
- A biopsy - a doctor removes a small amount of tissue for examination under a microscope. Other tests may indicate the presence of a tumour, but only a biopsy can make an accurate diagnosis. A biopsy is usually done as part of an operation to remove the mass.
- A lumbar puncture (spinal tap) - with the help of a needle, cerebrospinal fluid is sampled to be checked for malignant cells, blood, or tumour markers.
Early intervention offers the best chance of curing or controlling the disease and its side effects. For patients with a pituitary tumour, the following standard treatments are available:
- Drug treatment - is based on the body's hormone replacement which is affected by the tumour, and is called systemic therapy. Medicines are often given intravenously or as tablets or capsules.
- Surgery removes the tumour and some surrounding healthy tissue. It is the most common treatment for a pituitary gland tumour. A craniotomy is an operation which helps to remove a tumour through a hole in the skull. This operation accounts for 5% of surgical procedures to remove a tumour in the pituitary gland.
- Radiotherapy - uses high-energy beams to kill the tumour or stop its further growth. It uses a machine outside the patient's body to direct radiation to the area of the brain.
New treatment options
Some types of treatment are considered standard, as they have been used in medical practice for a long time. And some varieties are undergoing clinical trials and, through their approval, are also being introduced into the method of treating oncological diseases. It includes:
- Endoscopic transsphenoidal surgery is a surgery approach when an endoscope is inserted through a cut inside the nose. It goes through the sphenoid bone to reach the pituitary gland. An endoscope is a thin, tubular instrument with a light, a viewing lens, and a tool for removing tumour tissue.
- CyberKnife and GammaKnife are advanced radiation therapy that uses multiple focused beams of high-dose gamma radiation to target a specific area without affecting the surrounding brain. As a result, this treatment tends to cause less damage to tissues adjacent to the pituitary gland and can be completed in fewer sessions. In addition, it results in fewer side effects. Since these procedures are minimally invasive, they carry no risks associated with surgery, are less painful, and have minimal recovery after the process.
- Proton treatment uses a different type of radiation called proton beams. It can typically be more targeted than usual radiotherapy and delivers higher doses of energy, providing a greater chance of tumour control and a higher risk of damage to surrounding normal brain tissue.
Doctors continue to work to learn more about pituitary growths, how to prevent them, how best to treat them, and how to provide the best care for affected people.
Statistics and prognosis
The actual number of pituitary neoplasm can be much higher than the number of tumours detected each year. When examining people (postmortem autopsy) or imaging studies (such as an MRI scan) of the brain, doctors have found that 1 in 4 people may have a pituitary adenoma without knowing it. These tumours are often small and never cause any symptoms or health problems, so very few of them are usually diagnosed at all.
Comprehensive studies on the incidence and prognosis of pituitary tumours are still insufficient. Analyzing all pituitary adenomas registered in the surveillance, epidemiology and end results (SEER) database from 2004 to 2016 in the United States is even more interesting. Among all patients diagnosed with a tumour in the pituitary gland, 73% were between 19 and 64 years. 45% of patients underwent surgical resection, and the majority (94%) received surgery as their only treatment. In addition, 4% received radiation therapy. The overall incidence rate was 4.8 cases per 100,000 people, and most patients were female - 56%. Overall survival at 3, 5, and 10 years was 94.3%, 91.3%, and 83.1%.
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- Scientific Reports: Incidence, demographics, and survival of patients with primary pituitary tumors: a SEER database study in 2004–2016
- Oxford University Press: Diagnosis and Management of Pituitary Carcinomas
- American Society of Clinical Oncology (ASCO): Pituitary Gland Tumor: Latest Research
- American Cancer Society: Treating Pituitary Tumors
- National Cancer Institute: Pituitary Tumors Treatment (PDQ®)–Patient Version
- American Association of Neurological Surgeons: Pituitary Gland and Pituitary Tumors