Pituitary gland tumor treatment

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A pituitary gland tumour is a group of neoplasms which begin in hypophysis. It is divided into adenomas (benign tumours) and pituitary carcinomas (malignant). Hormonal tests and brain MRI help to diagnose tumours. Treatment consists of surgery, different types of radiation therapy and medications. In most complicated cases, doctors use palliative care.

A pituitary tumour is an abnormal growth of malignant cells in the pituitary gland, also known as hypophysis. The gland has two parts, and the neoplasm can start growing in either. Usually, pituitary tumours are benign and begin their development in the anterior lobe.

Depending on the malignancy, as well as on localization, pituitary tumours are divided into:

  • Pituitary adenomas are typically one-placed benign neoplasms located in tiny spaces in the skull and don't spread outside the brain. Nevertheless, even small pituitary adenoma might be a reason for severe health problems. Due to hormone production, pituitary adenomas are classified as functional (the lumps produce specific substances and change overall hormonal level) and non-functional or null cell adenomas.
  • Pituitary carcinomas are rare malignant neoplasms, so-called pituitary cancer. The tumours can spread as all cancers ad require urgent interventions.

It's worth mentioning that neurosurgeons divide the tumours by their size. There are microadenomas (less than 10mm) and macroadenomas (10mm and bigger). Statistics show macroadenomas are two to three times more common than small hypophysis tumours.

Pituitary gland tumours account for 17% of all primary brain tumours. Although hypophysis formations can occur at any age, older people are more susceptible. In addition, females are more likely to suffer than males.

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Causes for pituitary tumour

Until now, it is unknown why the pituitary gland cells begin to produce a tumour. However, it is known that there are changes in DNA and genes.

Oncogenes are genes that help cancer cells grow and divide. Tumour suppressor genes slow down the division of tumour cells and make them die. It is assumed that tumour development is caused by DNA changes that increase the action of oncogenes or reduce the number and activity of tumour suppressor genes.

Risk factors that increase the probability of developing a pituitary tumour are these hereditary syndromes: McCune-Albright syndrome, MEN1 and MEN4, carney complex and familial acromegaly. However, only these three genetic conditions have been confirmed to stimulate the development of a hypophysis neoplasm.

Hypophisal tumours have different symptoms and vary depending on the location (anterior or posterior lobe of the gland), stage of the neoplasm and the hormone they produce or do not produce.

Non-functional adenomas (inactive tumours) are usually found incidentally and may not cause any symptoms for a long time.

All possible signs of a pituitary tumour can be divided into the following groups:

  • Compression symptoms (pressing on brain structures): headaches, nausea and vomiting, dizziness, loss of consciousness, vision problems (blurred/double vision, loss of peripheral vision, sudden blindness).
  • Symptoms of increased hormone production:
    • Growth hormone (causes in children - gigantism, in adults - acromegaly, bone pain, excessive sweating).
    • Thyroid-stimulating hormone (fast or irregular heart rate, high blood pressure, trembling, nervousness and irritability, weight loss, increased sweating, anxiety, enlarged thyroid gland).
    • Adrenocorticotropic hormone (causes Cushing's syndrome or Cushing's disease. They provoke unexplained weight gain in the upper part of the body, stretch marks, increased hair growth, easy bruising on the skin, swelling face, acne, and high blood pressure and sugar).
    • Prolactin (causes in women - galactorrhea - secretion of breast milk, osteoporosis, decreased libido, irregular periods, absence of menstrual cycles. In men - breast growth and erectile dysfunction, infertility, osteoporosis).
    • Gonadotropins (usually are not strong enough to cause symptoms but sometimes cause irregular menstrual periods and infertility).
  • Symptoms of hormonal deficiency: general weakness, fatigue, hair loss, decreased libido, increase or decrease in body weight, an inability to breastfeed, low blood pressure/pulse, low blood sugar, and irregular menstrual cycles.

The range of diagnostic options for pituitary tumours

To diagnose pituitary tumours, doctors use a variety of laboratory and instrumental techniques. If you have a family history of one of the genetic syndromes listed above, you are at an increased risk of developing a hypophysial lesion. In this case, it is recommended to take a blood test for pituitary hormones regularly. Such screening makes it possible to detect a tumour at an early stage.

Usually, a pituitary tumour is rarely found — most frequently during a check-up for another disease. However, if the condition is suspected, laboratory tests of blood and urine are prescribed. It will help determine if the adenoma is functional (producing hormones) or doesn't cause any hormonal shift.

When the tumour grows and presses on adjacent structures of the brain (tissues, nerves) or extends beyond the pituitary fossa, neurological symptoms might occur. A neurological assessment will be required in such cases to detect them. Tests will include checking for reflexes, motor and sensory functions, coordination and mental status. In addition, the visual fields are tested.

A magnetic resonance imaging scan (MRI) - is the best visualizing method for exploring pituitary lesions. MRI creates images using strong magnetic fields. It allows doctors to see changes in places difficult to visualize with other techniques. Modern MRI machines can detect neoplasms less than 3 mm in diameter. Computed tomography (CT-scan) - uses x-rays to create detailed 3D images. For example, a CT might show a pituitary adenoma's size, shape, and location only if it is large enough.

A biopsy is a removal of a small piece of tumour tissue for subsequent examination under a microscope. This method is usually not performed before the surgery. Since to determine the type of tumour, it is enough to conduct laboratory tests and imaging. Frequently, it is done during the surgical removal to check for the tissue type. If a biopsy is required before the operation, it is performed under CT guidance, which helps to choose the right direction of the needle. Doctors use a biopsy to confirm the type of tumour and prescribe a specific treatment.

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Best pituitary tumour treatment solutions

The treatment of pituitary gland neoplasms is carried out by a team of doctors of different specialities since the therapy combines various treatment types.

The treatment strategy depends on the type of tumour (biopsy result), size (checked by MRI scan), location and general condition of the patient. Leading neurosurgeons conclude that surgery is the primary treatment for most pituitary tumours. However, the type of surgery and its success depends on the type of tumour, its size, and whether it has spread to other structures. Neurosurgeons distinguish the following surgical approaches:

  • Transsphenoidal surgery (95% of all operations) - is performed through the sphenoid sinus (enters throughout the nose). Doctors can reach the pituitary gland in two ways, through an incision (along the nasal septum or under the upper lip) with an endoscope.
  • Craniotomy - surgeons reach the hypophysis through a hole in the skull (open brain surgery). It is used for large and complex pituitary tumours. This method is rare because it has side effects and many complications.

Radiation therapy - high-energy x-rays or gamma rays destroy tumour compartments. It is used if the surgery is not possible or doctors cannot remove the whole tumour during the operation. There are different types of radiation therapy applied for hypophysis:

  • Intensity-modulated radiation therapy (IMRT) is - a 3D radiotherapy method with fewer side effects. The technic uses many radiation sessions to deliver the required dose to the tumour.
  • Stereotactic radiosurgery - irradiating the neoplasm with a hefty dose of radiation in one session, without incisions (sometimes, in several sessions if necessary).
  • Proton beam radiation therapy - a beam of protons kills tumour cells without harming the body's healthy tissues.

Drug therapy - taking medications is prescribed for deficiency or extra hormones produced by the tumour. Types of drug therapy:

  • Hormone replacement therapy - is specified when the pituitary gland does not have enough hormones.
  • With excessive production of hormones, drugs are taken that eliminate excess substances.

Although pituitary carcinomas (pituitary cancer) are rare, they do occur. They spread to other body parts (brain, spinal cord, meninges, and sometimes to the heart, liver, or lungs). This type of pituitary gland tumour is hard to treat. Therefore, therapy is focused on relieving the symptoms caused by cancer. It is called palliative care. Such treatment is advised in advanced stages when doctors can't perform the surgery.

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What can someone with a pituitary tumour expect?

The prognosis for pituitary tumours is determined by the time of diagnosis of the neoplasm, the size, hormonal activity and the treatment choice. Generally, the disease has a favourable prognosis if appropriately treated.

Restoration of the hormonal function is observed in 70-80% of cases, depending on the adenoma type. Unfortunately, some adenomas (prolactinomas and somatotropinomas) are completely curable only in 25% of cases.

Usually, tumours larger than 20 mm can not be completely removed during surgery. For this reason, recurrence is possible within five years after the operation.

FAQ

Can I get cured of a pituitary tumour?

Almost all pituitary tumours are curable. In the case of a timely detected benign adenoma, the prospects for recovery are excellent. However, a malignant tumour (carcinoma) might be challenging to treat completely.

Is the surgery the best option for pituitary gland tumours?

Small adenomas are best removed surgically. However, the larger the tumour, the more difficult it is to remove it altogether. Therefore, doctors use other treatment methods.

What is the best surgical approach available for the pituitary tumour?

The transsphenoidal approach is the best and safest for pituitary tumour treatment. This technique is often used for the following benefits: less traumatic for the brain tissues; no visible scars; the success rate is over 80%.

Is pituitary surgery risky?

Any surgical operation on the pituitary gland is risky. Possible complications during or after surgery include reaction to anaesthesia, bleeding, and entry of infection (meningitis, for example). In addition, after an operation, headaches might last 1-2 weeks..

Should I consider pituitary tumour surgery abroad?

Definitely yes. The operation's success largely depends on the professionalism of the doctors and the equipment used. In foreign clinics, special departments have high-tech techniques for performing neurosurgical procedures. And doctors, in addition to the rich experience, constantly take refresher courses.
 

Where can I get Pituitary gland tumor treatment?

Germany, Poland, Turkey, Spain, Lithuania are among the best for Pituitary gland tumor treatment.

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