Summary about Disease
A pituitary adenoma is a benign (non-cancerous) tumor that develops in the pituitary gland. The pituitary gland is a small, pea-sized gland located at the base of the brain that produces hormones which regulate various bodily functions. Pituitary adenomas can be functioning (producing excess hormones) or non-functioning (not producing excess hormones). Functioning adenomas can lead to hormonal imbalances, while non-functioning adenomas can cause problems by pressing on the pituitary gland or surrounding structures.
Symptoms
Symptoms vary depending on whether the adenoma is functioning or non-functioning, and on its size.
Functioning Adenomas: Specific symptoms depend on which hormone is being overproduced:
Prolactinomas (excess prolactin): In women, irregular periods, milk production (galactorrhea) even when not pregnant or breastfeeding, and infertility. In men, erectile dysfunction, decreased libido, and breast enlargement (gynecomastia).
Growth hormone-secreting adenomas (acromegaly): Enlarged hands and feet, coarse facial features, excessive sweating, joint pain, high blood sugar, sleep apnea.
ACTH-secreting adenomas (Cushing's disease): Weight gain (especially in the face, neck, and abdomen), high blood pressure, skin changes (easy bruising, purple stretch marks), muscle weakness, diabetes.
TSH-secreting adenomas (hyperthyroidism): Rare; symptoms of hyperthyroidism like rapid heartbeat, weight loss, anxiety, and sweating.
Non-Functioning Adenomas:
Headaches
Vision problems (blurred vision, double vision, loss of peripheral vision) due to pressure on the optic nerve.
Symptoms of hypopituitarism (hormone deficiencies) such as fatigue, weakness, decreased libido, menstrual irregularities, and cold sensitivity.
Causes
The exact cause of pituitary adenomas is not fully understood. Most arise sporadically, meaning they occur without a known cause. Genetic factors play a role in a small percentage of cases, particularly in conditions like Multiple Endocrine Neoplasia type 1 (MEN1).
Medicine Used
Treatment depends on the type, size, and symptoms of the adenoma.
Prolactinomas:
Dopamine agonists (e.g., bromocriptine, cabergoline): These medications are the first-line treatment and can effectively shrink the tumor and normalize prolactin levels.
Growth hormone-secreting adenomas:
Somatostatin analogs (e.g., octreotide, lanreotide): These medications block the release of growth hormone.
Growth hormone receptor antagonists (e.g., pegvisomant): These medications block the action of growth hormone.
ACTH-secreting adenomas:
Ketoconazole, metyrapone, osilodrostat, levoketoconazole: These medications block cortisol production.
Pasireotide: Somatostatin analog that can sometimes be used.
Non-functioning adenomas and those resistant to medication:
Surgery is often necessary. Transsphenoidal surgery is the most common approach, where the tumor is removed through the nose.
Radiation therapy may be used if surgery is not completely successful or not possible.
Is Communicable
No, pituitary adenomas are not communicable or contagious. They are not caused by infections and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent the development of pituitary adenomas, as the cause is largely unknown. For individuals with a family history of genetic syndromes like MEN1, genetic counseling and regular screening may be recommended.
How long does an outbreak last?
Pituitary adenomas do not involve outbreaks. They are tumors that develop over time. Symptoms can be persistent unless treated.
How is it diagnosed?
Diagnosis typically involves:
Medical history and physical examination: To assess symptoms and risk factors.
Hormone testing: Blood tests to measure hormone levels (prolactin, growth hormone, ACTH, TSH, etc.) and assess pituitary function.
MRI of the pituitary gland: This is the primary imaging test to visualize the pituitary gland and identify any tumors.
Visual field testing: To assess for any vision problems caused by compression of the optic nerve.
Timeline of Symptoms
The timeline of symptoms can vary greatly depending on the type and size of the adenoma.
Symptoms can develop gradually over months or years, especially with functioning adenomas.
Non-functioning adenomas may not cause noticeable symptoms until they become large enough to compress surrounding structures, leading to headaches or vision problems.
The speed of symptom progression depends on the rate of tumor growth and the degree of hormonal imbalance.
Important Considerations
Pituitary adenomas are generally benign and treatable.
Early diagnosis and treatment are important to prevent long-term complications such as vision loss, hormonal imbalances, and other health problems.
Treatment options should be individualized based on the specific characteristics of the adenoma and the patient's overall health.
Long-term monitoring is often necessary to assess for recurrence or complications of treatment.
Patients should discuss the risks and benefits of each treatment option with their healthcare provider to make informed decisions.