Pituitary Gland and Pituitary Tumors

 

Pituitary Tumors

Pituitary tumors are the most common intracranial tumors (accounting for 10% of central nervous system tumors), and the pituitary tumor is the growth of abnormal cells in the pituitary tissue. And control of pituitary hormones in many other glands in the body, which makes the tumor have a significant impact on the secretion of hormones in the body.

The presence of certain genetic conditions increases the risk of disease, and signs of the pituitary tumor include vision problems, and specific physical changes, radiography, and tests are used. Which examines blood and urine to detect a pituitary tumor, and individual factors influence the chance of recovery and treatment options for pituitary tumors.

What are pituitary tumors?

The pituitary gland is located at the base of the brain behind the nose and is the size of a pea. Although small, this gland is a significant component of the endocrine system (hormone secretion system).

This gland secretes many hormones that operate independently like the hormone Growth and prolactin secretion hormone. As well as hormones that affect other endocrine glands. Such as the thyroid, adrenal, testicles, and ovaries, in fact, they're almost no system in the body that actually not affected by the activity of the pituitary gland.

  • Pituitary tumors can disrupt the activity of the hormonal system by secreting hormones without control. On the other hand, they can also interfere with the secretion of the natural hormone without secreting the hormone on its own.
  • Most pituitary tumors are benign (adenomas). That is, it is a tumor that doesn't penetrate into neighboring tissues and doesn't pass to the distal organs.
  • There are many treatment options for these tumors. Ranging from drugs that regulate their growth to surgery for the removal of pituitary tumors.
  • There are two types of pituitary tumors: secretory (which produces hormones). And non-secretory (which don’t produce hormones).
  • Secretory tumors cause various problems. Which depend on the hormone they produce.
  • Non-secretory tumors can a problem if they are huge because they put pressure on the pituitary gland of the brain. And this pressure can interfere with the normal function of the pituitary gland.
  • Tumors less than 1 cm long (a small tumor) called. A, and rarely cause these problems, and large tumors (1 cm or more) tend to pressure the pituitary or adjacent parts.

What are the functions of the pituitary gland?

The pituitary gland manages a group of endocrine glands, through various hormones. And the five main hormones that secreted from this gland and its functions are as follows:

  • TSH (a thyroid-stimulating hormone): Controls the production of vital thyroid hormones from the thyroid gland located in the front of the throat. Without this hormone, mental activities and metabolism in the body slow down.
  • FSH / LH (hormones that stimulate the genitals): stimulate the testes in men and ovaries in women, and thus maintain sexual functions and reproduction.
  • ACTH (a hormone that stimulates the adrenal gland): Controls the secretion of the vital hormone called cortisol from the adrenal gland. The cortisol ensures that the immune system works regularly, and that fluid in blood pressure and blood vessels remains sufficient.
  • GH (Growth Hormone): It is responsible for the growth in adolescence. However, many vital functions have mentioned for the hormone in adulthood. As it has many functions such as organizing memory and mental functions and regulating the percentage of body and muscle fat, strengthening bone tissue, reducing the risk of heart disease.
  • Prolactin (a hormone that stimulates milk production): It is the main hormone for postpartum breastfeeding in women; however, it has been shown to have a role in the immune system in recent years.

Causes of pituitary tumors

  • Pituitary tumors come third among all tumors in the head. So it is a relatively common tumor, and the reasons for their appearance not fully understood.
  • Currently, researchers don’t know the cause of pituitary tumors. However, research studies show that everyone who has a genetic disease, type 1 multiple endocrine tumors, increases the risk of developing pituitary, thyroid, and pancreatic tumors.
  • Multiple type 1 endocrine tumors appear to be responsible for a small percentage of all pituitary tumors.
  • Although the vast majority have no genetic factors for the condition, researchers nevertheless believe that genetic mutations may be involved in the reasons why a person has a tumor in the gland.
  • Exposure to radiation or some chemical agents can cause mutations that can cause pituitary tumors.
  • It has been proven that pituitary insufficiency may develop in patients after head injuries (traffic accidents or headaches due to falls or combat sports such as boxing).

Symptoms of pituitary tumors

Pituitary tumors often asymptomatic, and their discovery causal when a brain scan carried out for another reason. Symptoms related to tumor size. Relationship to adjacent parts, and hormone production.

Symptoms divided into groups:

Symptoms related to compression of adjacent parts

Depending on their size and location, a headache or a change in the sense of sight can be caused by the tumor's pressure on the optic nerves (more vision loss in one or both eyes).

Symptoms associated with hormone deficiency

pressure on a healthy pituitary gland change the natural secretion of pituitary hormones. The lack of any of these hormones may require alternative treatment.

So all pituitary hormones must evaluated in the pituitary tumor. And this type of tumor can lead to fatigue Weight gain, decreased libido, menstrual shift, mood changes.

Excessive hormonal secretion

It occurs in pituitary tumors, and symptoms vary according to the hormone that secreted.

Prolactinoma

It is the most common tumor of benign pituitary tumors, due to the increase in prolactin secretion in women. It is evident by changing menstruation date, galactorrhea (milk secretion from the nipple). And decreased sexual desire, while in males, the disease is associated with decreased sexual desire and weak erection.

Somatic tumor

This is due to the increased production of growth hormone, and it appears during childhood. The symptoms can be very progressive. And what distinguishes them is the gradual increase in the size of the hands and feet and jaw with the appearance of the growth of the lips and nose, and increased sweating.

Thyroid tumor

It is production (TSH), which clinically leads to hyperthyroidism due to excessive production of thyroxine, but they are very rare.

Cortical tumor

also known as Cushing's syndrome, due to increased production of corticotropin (ACTH). And clinically affected people tend to gain weight, the appearance of high blood pressure, diabetes, and osteoporosis.

Complications of pituitary tumors

Anything that increases the likelihood of getting sick becomes a risk factor. The presence of a risk factor doesn’t mean that you will have cancer, but the absence of risk factors means that you are safe until now. The treatment should speeded up so that it doesn’t get worse, consult your doctor if you are in danger, don’t tend pituitary tumors may grow significantly or spread to other organs, but it can cause the following:

  • Vision loss: The pituitary gland is located exactly where the optic nerves from the eyes meet. The pressure of the tumor on the optic nerves leads to poor functions and loss of parts of the visual sense, and in particularly difficult situations, it is possible to lose vision completely.
  • Fixed hormone deficiency: the tumor itself or its eradication can stop a permanent hormone from the gland and the need for external hormone therapy.
  • Bleeding in the tumor: It is a rare, but very severe, life-threatening condition. Bleeding from the tumor leads to immediate loss of vision, severe headache, and immediate deficiency of glandular hormones that cause dizziness, intolerance to cold, vomiting, severe thirst, and fatigue. This condition requires urgent treatment through medication, sometimes surgery.
  • Diabetes: This condition is caused by an abnormally large tumor or after unsuccessful tumor removal.
  • The pituitary tumors cause the intense secretion of the hormone ADH, which is responsible for absorbing water in the kidneys, causing the release of large amounts of urine sometimes more than 10 liters per day, and it can lead to severe dehydration.

Diagnosis of pituitary tumors

Pituitary tumors often diagnosed accidentally by a radiological examination of the brain, a test, and magnetic resonance imaging is the ideal test to assess the pituitary tumor. This allows us to evaluate the type of pituitary tumors and their symptoms and the size and relationship with adjacent parts. When the presence of the pituitary tumors confirmed, a blood test performed to evaluate both pituitary hormones and whether there is any hormonal deficiency or hormone over-expression.

  • Blood test: In studying pituitary tumors. It is necessary to perform the examination and properly evaluate the different hormones. The checks carried out first in the morning because the hormones have variable production throughout the day, from time to time it done in the afternoon or evening to assess the daily rhythm. In general, Blood tests are sufficient. Still, if Cushing's disease suspected or excluded, it often necessary to obtain a 24-hour urine sample or samples of night saliva.
  • Functional test: It used to study a possible increase or deficit in hormonal production. In stimulation tests, a catalyst injected, or physical forces are stimulated by thirst or exercise, and blood samples obtained over a few hours to see the hormonal response to this stimulus.
  • Brain MRI: The image of the inner part of the brain is rebuilt, where the pituitary gland located.
  • Ophthalmology evaluation: Because of the proximity of the pituitary gland to the optic nerves, there may be changes in the visual field. Thus, it is vital to evaluate ophthalmology. A direct examination of the retina using the fundus performed.
  • Family history examination: It performed when a disease is suspected with a family history of this disease. It is done through a blood test.

Malignant pituitary tumors

  • Carcinomas in the pituitary gland are rare and can occur at any age, but most are diagnosed in the elderly. These tumors usually produce hormones like many glandular tumors.
  • Most pituitary tumors are very similar to each other when viewed under a microscope, in fact, and there is no good way to know if a pituitary tumor is cancer or an adenoma until it spreads to other organs. If this happens, it is usually 5 to 10 years after the first surgery.
  • Malignant pituitary tumors often spread to the brain, spinal cord, meninges, or bones around the pituitary gland. These tumors rarely spread to other organs such as the liver or lungs.
  • Chemotherapy and radiation are relied on during this type of tumor to improve a patient's life and prevent disease progression.

Benign pituitary tumors

  • Pituitary tumors are usually benign, called adenomas; adenomas are more common than one might think.
  • These pituitary tumors are often asymptomatic and silent. Some of which mistakenly detected by an MRI scan of the head that was requested for another reason.
  • Pituitary tumors are commonly classified as significant (higher than 1 cm) or small (neuroma).
  • Its treatment is diagnosed based on its size, growth rate, hormonal secretion, and location.
  • Benign pituitary tumors don't spread throughout the body because they are not cancer and usually remain within the boundaries of the pituitary gland's location. Yet, they can grow and press on neighboring areas such as the optic nerve and sinuses, but it is usually easy to treat and can be eliminated with high chances of recovery.
  • Pituitary adenomas can cause headaches, blindness, fainting, nausea, and vomiting, as well as symptoms associated with hormonal imbalances.
  • Tumors that secrete hormones can cause different effects depending on the type of hormone they produce including:

Prolactin (reproductive problems and abnormal breast milk production), adrenal cortex (changes in body fat distribution, osteoporosis, and hair growth), growth hormone (growth) Hands, feet, jaw), and thyrotropin (palpitations and sweating).

Pituitary tumors in children

Pituitary tumors in children may cause many problems that caused by growth hormone, whether the growth hormone secretion increased or decreased:

  • HGH is one of many hormones in our bodies, and this hormone excreted in the blood by the hypothalamus and the pituitary gland in the brain. The role of HGH is to control the growth of bones, muscles, and organs.
  • HGH deficiency occurs when the pituitary gland cannot produce enough HGH.
  • There are various causes for a lack of growth hormone. However, in many cases, the primary purpose not fully determined; sometimes, it occurs due to damage to the pituitary gland during childbirth. Occasionally severe head trauma occurs as a result of damage to the hypothalamus and pituitary gland due to pituitary tumors and radiotherapy.
  • The most relevant results for growth hormone deficiency in children are short stature, mental, and physical delay.
  • Growth hormone secretion may increase during tumors of the pituitary gland and thus cause many damages such as enlarged limbs such as hands, feet, and jaws.

How to treat pituitary tumors

Pituitary tumors and their treatment vary according to the type of tumor, its rate of growth, the patient's age, the initial size of the tumor, and the symptoms it causes for the patient.

The treatment decision is usually made by a team of doctors from several specialties.

Thus. The treatment process includes endocrinologist, neurologist, and neurosurgeon:

Surgery
  • Surgery performed to remove the tumor by opening the skull and reaching the tumor from above; this approach is currently less used due to the presence of many complications.
  • Another approach is the approach through the nose through the endoscope. And doctors in this way reach the tumor through the nose without opening the skull. And this method has fewer complications and a slight risk of damage to nearby parts of the brain.
Radiation therapy
  • High-energy X-rays use to kill cancer cells. This method used in some cases after surgery to complete treatment. Or in situations where surgery can't perform due to the size or location of the tumor.
Chemotherapy
  • Chemotherapy can use as a palliative treatment for pituitary cancer. To relieve symptoms and improve the quality of life of the patient.
  • Chemotherapy used as a drug that interferes with the formation of cancer cells and also used to prevent proliferation. And chemotherapy inserted either orally or into the bloodstream. And a method of Chemotherapy depends on the type of cancer treated.
Medicines
  • Drug therapy can reduce the increased secretion of hormones from tumor cells or reduce the size and symptoms of pituitary tumors. Medicines have relied mainly on tumors that secrete growth hormone (somatostatin), or pituitary tumors secretions of prolactin.
  • Over 90% of pituitary tumors will respond well to treatments when using all of the above treatment options.
Delayed treatment
  • Delayed treatment is the process by which tumor growth and the effect of a tumor on the body observed without treatment applied. It is a preferred strategy when the tumor doesn't cause a symptom or change in hormone levels. Patients can survive without any treatment if the tumor of the pituitary gland doesn't cause a sign or change in hormone levels. The correct decision in this regard will taken by the medical team with an evaluation Patient.

Does the pituitary tumor affect the patient's age?

  • A pituitary tumor doesn’t shorten the patient's life as long as it is properly treated. As long as the patient receives complimentary hormonal treatments.
  • Hypothyroid hormone deficiency requires hormonal supplements. And all medications must used as prescribed by your doctor. Besides, these patients need regular screening and control of the hormone level.
  • Many patients who take the pituitary hormone do their regular work and participate in social activities.
  • If the patient uses cortisol, he should carry a card indicating this. And the amount of cortisol that the patient uses should increased.
  • In patients with uncontrolled adenomegaly (the absolute increase in growth hormone) or Cushing's disease. Life expectancy may decrease due to increased hormone and associated complications.

Prevention of pituitary tumors

Since there are no known causes of pituitary tumors' lifestyle or environmental causes. It is essential to remember that there is nothing that people with these tumors can do to prevent them.

Still, individuals who have a family history of this disease must always make sure to frequent examinations that individuals take care of the need to stop making mistakes. Such as smoking, malnutrition, or lack of exercise, to prevent damage that causes pituitary tumors.

vision loss

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