Pituitary adenoma
"Throughout these more than 20 years we have been developing endoscopic nasal surgery to make it safer and to achieve a higher rate of complete tumor resections".
DR. BARTOLOMÉ BEJARANO
SPECIALIST. CENTRAL NERVOUS SYSTEM TUMORS AREA
What is a pituitary adenoma?
A pituitary adenoma is a benign tumour that originates in the pituitary gland. The pituitary gland is a small gland located in the sella turcica, a bony depression at the base of the skull, and is responsible for controlling many bodily functions, hence its name as the master gland.
Pituitary adenomas can form from the pituitary gland, which are relatively common (1 to 8 cases per 100,000 inhabitants) and account for 10-15% of all intracranial tumours, with the highest incidence occurring in the 3rd and 4th decades of life.
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What are the symptoms of pituitary adenoma?
Pituitary tumours are divided into functioning and non-functioning.
Symptoms of functioning tumours
This type of tumour causes disease due to the excess of the hormone secreted into the bloodstream.
The most common are prolactinomas or prolactin producers, which cause absent or irregular menstruation in women, decreased libido in men and infertility and milk production (galactorrhoea) in men and women.
Most of these adenomas are treated pharmacologically by endocrinologists. In contrast, there are other functioning tumours such as GH (growth hormone) producing tumours that cause acromegaly (adults) or gigantism (children) and ACTH producing tumours that develop Cushing's disease due to excess cortisol (stress hormone). The main treatment is surgery.
Symptoms of non-functioning tumours
Unlike the previous ones, non-functioning tumours do not produce hormones, so they go unnoticed until they reach a certain size, causing hormonal deficits due to compression of the normal pituitary gland.In addition, if the adenoma progresses and grows excessively, it can protrude from the sella turcica, compressing neighbouring structures, such as the optic pathways, and can cause progressive visual loss (in some cases this can be sudden due to bleeding from the tumour).
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
Types of pituitary adenoma
Depending on size:
- Microadenomas (smaller than 1 cm)
- Macroadenomas (larger than 1 cm)
Between 70 and 90% of patients with a pituitary macroadenoma have deficits in one or more pituitary hormones at the time of diagnosis, while the percentage is lower in microadenomas.
Depending on whether they secrete hormones themselves or not:
- Functioning (secreting)
- Non-functioning (non-secretory)
Causes of a pituitary adenoma
For the vast majority of pituitary adenomas the cause is still unknown, although research in this field continues.
Only a genetic predisposition is known with certainty in what we call Multiple Endocrine Neoplasia Syndrome Type 1 (MEN-1), linked to an alteration of chromosome number 11.
But only 3% of pituitary adenomas occur in the context of these multiple endocrine tumours.
How is pituitary adenoma diagnosed?
Pituitary adenomas are often detected by chance during an MRI scan of the brain for another reason. The MRI makes it possible to assess the type, size and relationship of the tumour with neighbouring structures.
A blood test with hormone detection will be necessary to determine which hormones are being overproduced.
The diagnosis is completed with an ophthalmological examination to assess whether the adenoma may be causing compression of the optic chiasm.
Treatment for pituitary adenoma
Although the treatment of choice is surgery, a combination of different types of treatment is common.
Current treatment options include:
- Pharmacological and hormone replacement therapy
- Surgery (microsurgical or endoscopic transsphenoidal and transcranial)
- Radiotherapy/radiosurgery
Medications that block hormone secretion can control symptoms and sometimes reduce the size of the tumor, especially in prolactinomas.
If the pituitary gland were damaged during surgery, the patient would subsequently require treatment to replace the deficient hormones (cortisol, GH, thyroid hormone, estrogens, testosterone, antidiuretic hormone).
Today, the great development of endoscopy makes possible the removal of most of these tumors through the nasal cavity, being very exceptional the need for a craniotomy (opening of the skull).
In addition, the collaboration of the neurosurgeon with the otolaryngologist allows the execution of procedures that are less and less cruel and more complex under modern systems of lenses, cameras and high definition monitors.
Endoscopic nasal surgery consists of introducing an endoscope through the nostrils, which slides between the middle turbinate and the nasal septum, until the sphenoid hole is located. This hole is enlarged to achieve a sufficient opening of the sphenoidal sinus, allowing the floor of the Turkish saddle to be visualized for the removal of the tumor.
Unlike the conventional microscopic technique, there is usually no nasal packing left.
After the operation, the patient goes to the ICU and, the next day, to the ward, where he is assessed by Neurosurgery, Otolaryngology and Endocrinology.
As for the hospital stay after surgery, in uncomplicated cases 3-4 days are sufficient. However, sometimes, due to the hormonal pituitary pathology itself (especially in Cushing's disease), the endocrinologist has to perform several analytical studies and adjust the medication, so the stay can be extended a few days more.
Where do we treat it?
IN NAVARRA AND MADRID
Central Nervous System Tumors Area
of the Cancer Center Clínica Universidad de Navarra
In the Central Nervous System Tumors Area we offer maximum safety and efficiency in brain tumor surgery, being the first hospital with a high field magnetic resonance within the operating room.
We have a highly specialized team in the surgery of brain tumors, with more than 15 years of experience.
The individualized treatment of each case by an interdisciplinary team allows us to offer the best alternative to each patient.
Why at the Clinica?
- Integral evaluation of the patient.
- Cutting edge technology.
- Expert professionals who are a national reference.
Our pituitary adenoma expert team
