symptoms

The main symptom that results from these tumors is the alteration in the secretion of hormones. Depending on the incidence of the tumor in the pituitary, these can produce too much of one or more hormones. As a consequence of this alteration in the endocrine system the Symptoms can be:

• Hyperthyroidism : the thyroid gland produces excessive amounts of hormones; This symptom is quite unusual in those affected by a hypophyseal adenoma.
• Cushing’s syndrome : the level of the hormone cortisol is higher than normal.
• Gigantism or acromegaly : in the case of a higher growth hormone level in children gigantism will occur and in the case that this occurs in adults we will talk about acromegaly.
• Secretion and milk production in men and women (galactorrhea), due to an increase in prolactin secretion
• Menstrual periods absent (amenorrhea) or irregular in women, due to alteration of sex hormones.

Symptoms that result from the compression of brain structures of a large pituitary tumor may include:

• Visual disturbances such as double vision, loss of visual field, drooping eyelids or changes in color vision.
• Headache.
• Tiredness and sleepiness
• Nasal flow of clear liquid.
• Nausea and vomiting.
• Problems with the sense of smell
• When these symptoms occur suddenly and simultaneously they can be serious and cause a hypophysis infarction.

Prevention

Because the causes that cause the pituitary tumor are not known, there are no specific guidelines for its prevention.

Types

They can be classified according to the size and the incidence they have in the hormonal formation. According to the size they can be:

• Microadenomas : less than 1 cm.
• Macroadenomas : greater than 1 cm, these have a much higher percentage (70-90 percent) of causing deficits in one or more pituitary hormones than the microadenomas.

The classification according to whether they secrete hormones themselves or not is:

• Functioning : they secrete hormones by themselves.
• Not working : they do not secrete hormones.

Diagnosis

First of all, it is necessary to perform a physical examination where the doctor will analyze any problem of double vision and visual field, such as the loss of lateral (peripheral) vision or the ability to see in certain areas.

Then, an analysis of the endocrine function is performed to look for any signs of hormonal excess or irregularity, such as signs of too much cortisol (Cushing’s syndrome) or too much growth hormone (acromegaly).

The most relevant tests that help confirm the diagnosis are visual field and CT and brain MRI.

Treatments

Current therapeutic options include:

• Pharmacological treatment and hormone replacement: medications that block hormone secretion can control symptoms and even reduce the size of the tumor.
• Radiation therapy : it is usually used to decrease the size of the tumor.
• Surgery (transsphenoidal microsurgical or endoscopic and transcranial)

Currently, the development of endoscopy makes it possible for the removal of most of these tumors through the nasal cavity, so the need for a craniotomy (opening of the skull) is quite unusual.

The nasal endoscopic 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 orifice is enlarged to achieve a sufficient opening of the sphenoid sinus, which allows visualizing the floor of the sella turcica to extract the tumor.

Other data

Forecast

In most cases the tumor can be surgically removed and the prognosis is acceptable to good, depending on whether the entire tumor is removed.

The most serious complication is blindness, in case the optic nerve is severely damaged. The tumor or its removal can cause lifelong hormonal imbalances. It is possible that it is necessary to replace the affected hormones and, perhaps, that the patient needs to take drugs permanently.

Surgery can sometimes damage the posterior pituitary and cause diabetes insipidus, characterized by symptoms of frequent urination and extreme thirst.