“Understanding Pituitary Adenomas: Overview of Symptoms, Diagnosis, and Treatment Options”

Overview

Pituitary adenomas are a type of brain tumor that grows on the pituitary gland, induced by uncontrolled cell growth in the pituitary gland. Despite its benign and non-metastasizing nature, the tumor may be symptomatic as it can disrupt normal pituitary function and pressure the surrounding areas.

As the pituitary gland is in charge of producing a range of essential hormones that affect the systems of the whole body, it is recommended to treat pituitary adenomas immediately. Various treatment choices are available for pituitary adenomas, including surgery, medication, and radiation.

Symptoms 

There are two types of pituitary adenomas. The first one is secreting adenomas, which means the tumor produces extra hormones, causing different symptoms depending on the hormones released. The second one is non-secreting adenomas, which do not produce extra hormones and are more common than secreting adenomas.

In most cases, pituitary adenomas are larger than 10 millimeters. With such size, the tumor may cause hypopituitarism, a condition when the body suffers from a deficiency of pituitary hormones. Pituitary adenomas smaller than 10 millimeters, on the other hand, tend to be asymptomatic.

Pituitary adenomas are the most common in women aged 30–50. Approximately 77 individuals per 100,000 are affected by pituitary adenomas, symptomatic or not.

Pituitary adenomas may lead to one of these contrasting conditions, a shortage of pituitary hormones and a production of extra hormones.

Shortage of pituitary hormones includes testosterone, estrogen, cortisol, and growth hormone. The most common symptoms are visual impairments and headaches, which affect around half of the patients with the tumor.

The extra hormones produced due to pituitary adenomas include prolactin, cortisol, growth hormone, and adrenocorticotropic hormone. This may cause infertility, enlarged hands or feet, or an enlarged heart, depending on which extra hormone is made.

Diagnosis 

It may be hard to diagnose pituitary adenomas as the tumor may be asymptomatic, especially a small and non-secreting tumor. Even when the condition causes symptoms, especially secreting adenomas, these symptoms tend to overlap those of other causes. Blood tests, MRIs, and eye tests are often used to diagnose pituitary adenomas.

Treatment

Pituitary adenoma can be treated with surgery, medications, and/or radiation. Leaving pituitary adenomas untreated can lead to pituitary apoplexy, a medical emergency where the pituitary gland bleeds.

Medications prescribed to reduce the size of pituitary adenoma and regulate hormone levels include dopamine agonists. If medications have been proven ineffective, surgery may be recommended.

Depending on the tumor’s size and symptoms, SUrgery may need to be performed more than once. In almost all pituitary adenoma surgery, transsphenoidal surgery is performed, where the doctor makes access through the nose, sphenoid sinus, and a hollow space in the skull to remove the tumor. Transcranial surgery may be performed if the tumor is too large.

For radiation, stereotactic radiosurgery reduces the tumor size and prevents the tumor from growing.

It’s worth noting that surgery or radiation may cause hypopituitarism. This side effect can be treated with hormone replacement therapy. Surgery alone can cause cerebrospinal fluid leaks and diabetes insipidus. Dopamine agonists may cause headaches, dizziness, and vomiting. Most patients with pituitary adenomas can resume their regular lives. However, the disease has a recurrence rate of approximately 22%.