A pituitary tumor is a mostly benign tumor of the pituitary gland (hypophysis). Even if the pituitary tumor consists of benign cells in most cases, it does not always heal completely. Tumors of the pituitary gland are more common than generally assumed: There are 80 to 100 new cases per 100,000 people per year. They occur in people of all age groups.
You can find more information and pituitary adenoma specialists here.
The pituitary gland is a gland about the size of a cherry and consists of
The posterior lobe stores hormones from the hypothalamus, a nearby section of the brain. It releases these hormones when required.
The anterior lobe of the pituitary gland, on the other hand, produces hormones that are important for the body, such as
Pituitary adenomas are benign forms of pituitary tumors, i.e. tumors of the pituitary gland. About 10-15% of all intracranial tumors (tumors inside the skull) are pituitary tumors.
In terms of their benign or malignant nature, pituitary tumors can be divided into
can be subdivided.
Location of the pituitary gland directly below the brain © bilderzwerg | AdobeStock
Pituitary adenomas, abbreviated as H adenomas, grow in the sella turcica. This is a bone hollow near the point where the two optic nerves cross.
Doctors classify pituitary adenomas into different forms based on two characteristics:
Hormone-active adenomas include, among others
are distinguished. Depending on the hormone produced, these are then classified as, for example
for example. Around 23% of adenomas are hormone-inactive.
A pituitary carcinoma usually develops from a prolactinoma.
The more aggressive atypical adenomas grow into the neighboring brain tissue. They can then no longer be completely removed.
Changes in the genetic material of a cell in the pituitary gland can lead to uncontrolled cell division. This leads to the development of a lump, the pituitary tumor. The exact mechanisms are still unclear.
In some patients, the H adenoma occurs in connection with multiple endocrine neoplasia (MEN-1 syndrome). This is a hereditary glandular disease.
The signs of a pituitary tumor depend on the hormone activity and which hormones are involved. Depending on whether there is an excess or deficiency of hormones, the symptoms can be completely different.
For example, prolactinomas in women can cause
in non-pregnant women. In men it can
can occur.
Growth hormone-producing adenomas lead to gigantism (tall stature) even before puberty. In adults, there are changes in
Patients can present with a variety of symptoms. The most common are
In the case of ACTH-producing adenomas, the excess ACTH leads to Cushing's disease. Typical symptoms include
The hormone-inactive pituitary tumors displace surrounding hormone or nerve tissue as they grow. This can lead to hypopituitarism as well as impaired vision and visual fields.
Depending on which hormone is produced too little, this can lead to disorders
may occur.
As the H adenoma grows very slowly, the first signs of a pituitary tumor often only become apparent after many years.
Diagnostics are based on
The pathologically altered tissue can be clearly seen on an MRI. The radiologist can see exactly how large the pituitary adenoma is, where it is located and whether it has calcifications.
Saliva, blood and urine tests reveal which hormone is present in excess or in insufficient quantities.
A corticotropinoma can be detected using the dexamethasone test. Dexamethasone is a corticosteroid medication that is often used to reduce swelling in the brain.
An ophthalmologic examination is also useful, in particular visual field perimetry or computer-assisted perimetry. This makes it possible to determine whether the adenoma is pressing on or growing into structures of the visual pathway. This would manifest itself in a visual field restriction.
The treatment of a pituitary adenoma depends on
Some H adenomas do not cause any symptoms. In this case, it is usually sufficient to monitor its growth at regular intervals using imaging techniques.
Treatment is only carried out if the tumor causes the patient symptoms.
Some types of pituitary adenomas do not usually require surgery: prolactinomas, for example, are preferably treated with medication (dopamine agonists). In certain cases, however, surgical removal is also considered for prolactinomas. The conditions for this are, for example, if
The treatment of choice for growth hormone and ACTH-producing adenomas is pituitary surgery. The chances of success are very good.
As microadenomas are very small, they can be operated on through the nose . No visible scar remains on the head after pituitary adenoma surgery. In 9 out of 10 cases, the small tumors can be removed without leaving any tissue residue.
In the case of macroadenomas, it is necessary to open the skull.
Pituitary tumors are removed by a specialist in neurosurgery. Invasively growing adenomas cannot be completely removed surgically. The patient then often has to take hormones for the rest of their life.
Radiotherapy is only very rarely used for tumors, for example in the case of very large H adenomas. The doctors then try to shrink the tumor with radiotherapy before the pituitary adenoma operation.
If hormonal disorders are too severe, the patient is treated with medication before the surgical procedure.
Tumor-related hypofunction of the pituitary gland must be compensated for before and after surgery by administering hormones. This is known as hormone replacement therapy. Depending on the hormone deficiency, this may involve taking
mean.
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