Pituitary adenomas are tumors that originate from the cells of the pituitary gland, typically benign. The pituitary gland is a crucial organ that regulates hormone production in the body, and therefore, adenomas can lead to hormonal imbalances and symptoms due to pressure on adjacent tissues.

Classification

• Based on Hormone Production:

  • Functional Adenomas: Secrete excessive hormones.

    • Prolactinoma: Produces prolactin.

    • Acromegaly/Gigantism: Produces growth hormone.

    • Cushing's Disease: Secretes corticotropin (ACTH).

    • Thyrotropin Adenoma: Produces TSH (rare).

  • Nonfunctional Adenomas: Do not produce hormones; typically cause symptoms related to their size.

• Based on Size:

  • Microadenomas: Smaller than 10 mm.

  • Macroadenomas: Larger than 10 mm.

Symptoms

• Symptoms Due to Hormonal Excess:

  • Prolactinoma: Irregular periods, infertility, loss of libido in men, milk production from the nipples.

  • Excess Growth Hormone:

    • Gigantism in children: Excessive growth in height.

    • Acromegaly in adults: Growth of hands, feet, and face.

  • Excess ACTH: Symptoms of Cushing's disease due to increased cortisol (obesity, round face, muscle weakness).

• Symptoms Due to Tumor Growth:

  • Vision loss or blurriness (pressure on the optic nerves).

  • Headaches.

  • Insufficient secretion of other pituitary hormones (hypopituitarism).

Diagnostic Methods

• Laboratory Tests:

  • Measurement of hormone levels in blood and urine.

• Imaging:

  • MRI (Magnetic Resonance Imaging): Assesses the size of the adenoma and its relation to surrounding structures.

  • CT (Computed Tomography): Used in addition to MRI.

Treatment

• Medical Treatment:

  • Prolactinomas: Dopamine agonists (e.g., bromocriptine, cabergoline).

  • Hormone production can be reduced or controlled.

• Surgical Treatment:

  • The tumor is typically removed via endoscopic transsphenoidal surgery.

  • Preferred in macroadenomas or in cases where hormonal production cannot be controlled with medical treatment.

• Radiotherapy:

  • Used for tumors not amenable to surgery or for residual tumor tissue after surgery.

• Hormone Replacement:

  • To replace deficient hormones.

Prognosis

• Microadenomas generally have a good prognosis and can be controlled with medical treatment.

• Macroadenomas recovery depends on the size of the tumor and the damage to surrounding tissues.

• Early diagnosis and treatment are essential to prevent complications.