The pituitary gland is the “commander in chief” of our body. This small gland is responsible for the production of hormones, which in turn regulate the functioning of other glands and the production of dozens of other hormones. If the pituitary gland begins to produce substances in excess or insufficient quantities, this leads to the development of various diseases.
The SANMEDEXPERT clinic successfully diagnoses and treats pituitary dysfunction, which helps to effectively treat patients and prevent dozens of diseases.
Pituitary hormones:
The pituitary gland produces the following hormones:
- Prolactin - ensures the formation of milk during lactation, and also inhibits the production of follicle-stimulating and luteinizing hormones. Numerous other functions (eg, regulation of the immune and nervous systems) are currently being studied.
- Follicle-stimulating hormone - ensures the growth and maturation of follicles in the ovaries of women and spermatogenesis in men.
- Luteinizing hormone stimulates estrogen secretion and ovulation, and in men is responsible for the formation of testosterone.
- Thyroid-stimulating hormone, according to statistics, is the most frequently prescribed hormone for research. Ensures the growth of the thyroid gland and the production of peripheral thyroid hormones - thyroxine and triiodothyronine.
- Adrenocorticotropic hormone - controls the production of hormones from the adrenal cortex.
- Somatotropic hormone is the most important stimulator of protein synthesis in cells, glucose formation and fat breakdown, as well as body growth.
Diagnosis of pituitary adenoma
Typically, a neurologist, ophthalmologist and endocrinologist are involved in the diagnosis of pituitary adenoma. Patients turn to the first two specialists when ophthalmic and neurological symptoms develop, and to the last one when endocrine and metabolic symptoms develop. For a more accurate diagnosis, consultation with all these doctors will be required. Standard examination for pituitary adenoma includes:
- X-ray of the sella turcica
. Shows the contour, size, shape of the pituitary gland, signs of destruction of the dorsum sella; - MRI of the brain
. Allows you to identify microscopic neoplasms in tissues and evaluate its blood circulation; - CT scan of the skull
. Reflects a more precise localization of the adenoma in the brain; - Angiography
. It is prescribed if MRI and CT did not show an adenoma, but there are signs of its presence. The study allows us to identify tumors of the smallest size; - Hormonal blood test
. The concentrations of prolactin, somatotropin, cortisol, ACTH, TSH are determined; - Ophthalmic examination
. It is necessary to check visual acuity, the condition of the fundus, and the optic nerve; - Blood chemistry
. Determines the general condition of the body. It is important to check your glucose level - its increased value indicates a metabolic disorder.
Pituitary gland diseases:
Pituitary diseases are a large group of diseases that can be caused by the presence of a tumor of the pituitary gland or nearby structures, vascular pathology and inflammatory diseases, including granulomatous diseases.
Ultimately, this can lead to hypofunction, hyperfunction of the pituitary gland, and sometimes to mass effect.
Mass effect:
The mass effect of a large pituitary tumor causes blurred vision (due to compression of the optic chiasm) and headaches. If visual field impairment due to a pituitary tumor is suspected, consultation with an ophthalmologist . To diagnose the presence of a formation, MRI of the chiasmal-sellar region with contrast is used.
Hyperfunction of the pituitary gland:
Symptoms of pituitary hyperfunction are varied. Excess prolactin in women often causes lactorrhea, infertility and amenorrhea, and in men it can cause hypogonadism (decreased sexual function). An excess of somatotropic hormone causes gigantism in children, and characteristic changes in appearance (acromegaly) and organomegaly in adults. With an excess of adrenocorticotropic hormone (Cushing's disease), symptoms such as obesity with typical redistribution of fatty tissue on the arms and face, arterial hypertension, diabetes mellitus, and osteoporosis are described.
Hypofunction of the pituitary gland:
With hypofunction of the pituitary gland, hypogonadism develops (decreased sexual function), secondary adrenal insufficiency (low blood pressure, weight loss, decreased glucose levels), secondary hypothyroidism - decreased thyroid function (brittle hair and nails, drowsiness, swelling). Children may also experience delayed growth and sexual development.
Disorders of the pituitary gland
The functioning of all organs and systems of the human body is greatly influenced by hormones, which are produced by special endocrine glands, united in a common endocrine system, and enter the blood.
Hormones are produced by the thyroid and parathyroid glands, ovaries in women, testes and testicles in men, pancreas, hypothalamus and pituitary gland. The endocrine system is considered the most hierarchical and disciplined.
The most important part of the endocrine system is the pituitary gland. This is a gland, the size of which rarely exceeds the size of the nail on the little finger of a child. Located in the very center of the brain, the pituitary gland is responsible for the functioning of a large number of endocrine glands. At the same time, he himself secretes special hormones that influence the production of other hormones. For example, the pituitary gland releases TSH into the blood - thyroid-stimulating hormone, thanks to which the thyroid gland begins to create its own hormones thyroxine and triiodothyronine. The pituitary gland also produces hormones that have direct effects. Such hormones, for example, include growth hormone, a somatotropic hubbub that affects the growth process and physical development of the child.
If the pituitary gland produces insufficient or excessive amounts of hormones, this can lead to serious illnesses.
Consequences of a lack of pituitary hormones
Insufficient production of pituitary hormones leads to the following consequences:
- a secondary deficiency of hormones produced by other endocrine glands occurs, for example, secondary hypothyroidism may develop - a deficiency of thyroid hormones;
- serious disturbances appear in the physical development of the body, for example, with a deficiency of somatotropic hormone in childhood, dwarfism may develop;
- the development of diabetes insipidus, which occurs when there is insufficient amount of antidiuretic hormone (ADH) produced in the hypothalamus, which then enters the pituitary gland and is released from it into the blood;
- the development of hypopituitarism, which occurs in case of deficiencies of all hormones produced by the pituitary gland. In children, in this case, sexual development is delayed, and in adults, sexual disorders occur. The result of hypopituitarism is severe metabolic disorders that extend to all body systems.
Consequences of excess pituitary hormones
If the pituitary gland produces an excess amount of hormones, the clinical picture varies greatly depending on how much and which hormones are produced above normal.
Excessive production of pituitary hormones leads to the following consequences:
- hyperprolactinemia occurs with high levels of propactin. In women, in this case, the menstrual cycle is disrupted, infertility develops, and lactation occurs, i.e., swelling of the mammary glands and secretion of milk occurs. In men, libido decreases and impotence develops;
- due to excess production of somatotropic hormone (GH), giants appear. If this disorder occurs at an early age, gigantism develops; if it occurs in an adult, acromegaly begins. The Guinness Book of Records contains an entry about the tallest man, Robert Pershing Wadlow, who was born in the USA in 1918. He was 2 meters 72 centimeters tall and had an arm span of 2 meters 88 centimeters. Another giant is recorded in the Russian Divo book of records - Russian Fedor Makhov. With a height of 2 meters 85 centimeters, he weighed 182 kilograms. A patient with acromegaly has thickening of the hands and feet, facial features become enlarged, and internal organs become enlarged. These changes lead to disorders of the cardiovascular system and neurological disorders.
Due to an increase in the amount of adrenocorticotropic hormone (ACTH) produced, Cushing's disease occurs. The manifestation of this disease is osteoporosis, low blood pressure, the development of diabetes mellitus, and mental disorders. During illness, the legs and arms lose weight, and obesity begins in the abdomen, shoulders and face.
Causes of pituitary gland diseases
When considering the causes of diseases of the pituitary gland, do not forget that it is located in the brain and is an integral part of it. The optic nerves are located above the pituitary gland; large vessels supplying the brain and nerves responsible for the motor function of the eyes pass on both sides of it.
Most often, an excess of pituitary hormones occurs due to a pituitary adenoma, i.e., a tumor of the pituitary gland. The adenoma cells begin to produce more of the hormone or hormones and at the same time compress the remaining part of the pituitary gland, which leads to a decrease in the level of all other hormones it produces. The growth of an adenoma can be dangerous in terms of compression of the optic nerves located next to it, as well as blood vessels and brain structures. Most patients with adenoma complain of headaches and blurred vision.
Pituitary hormone deficiency can occur due to the following factors:
- blood supply defects;
- hemorrhages;
- congenital hypoplasia of the pituitary gland;
- meningitis or encephalitis;
- compression of the pituitary gland by a tumor;
- traumatic brain injury;
- taking a number of medications;
- irradiation;
- surgical intervention.
Diagnosis and treatment of pituitary diseases
An endocrinologist is responsible for the diagnosis and treatment of pituitary gland diseases. During the first visit, the doctor must collect an anamnesis, which includes the patient’s complaints, information about the diseases he has suffered, as well as hereditary predisposition to various diseases. Based on the medical history, an appropriate hormonal profile study will be prescribed, i.e. a blood test for hormone levels, as well as a test with thyrotropin-releasing hormone, synacthen, etc. If necessary, the patient can be referred for a computed tomography scan of the brain or magnetic resonance imaging of the brain.
To treat pituitary disease, it is necessary to bring the level of hormones in the blood back to normal; if the patient has a developed adenoma, treatment should be used to reduce the pressure of the tumor on the surrounding brain structures. If the pituitary gland does not produce enough hormones, the patient is prescribed hormone replacement therapy in the form of medications that are analogues of the necessary hormones. Often this treatment can last a lifetime. Fortunately for the patient, pituitary adenoma becomes malignant only in extremely rare cases, but they are quite difficult to cure. In this case, doctors use a number of methods that can be used either individually or in combination. These include:
- drug therapy;
- surgical removal of the tumor;
- various types of radiation therapy.
Diagnosis and treatment:
Pituitary gland disease can be suspected at an appointment with an endocrinologist during a detailed questioning and examination of the patient, after which, if necessary, hormonal and instrumental examinations are prescribed. Often, the primary diagnosis of pituitary diseases is carried out by the level of the hormone at the peripheral level (for example, if Cushing's disease is suspected, excess cortisol, an adrenal hormone, is excluded). It is worth noting that when studying the levels of many hormones (prolactin, cortisol, ACTH, etc.), certain rules must be followed, since the values of these hormones change significantly depending on the time of day, the menstrual cycle and other conditions. For further diagnosis, functional tests may be required (for example, a test with dexamethasone when diagnosing Cushing's disease).
Depending on the specifics of the disease, the patient may be offered surgical treatment (for example, for a pituitary tumor). However, it is worth knowing that prolactinoma is one of the few tumors that can be treated conservatively (with the help of medications). If a hormone deficiency is detected, hormone replacement therapy may be prescribed.
What is a pituitary adenoma?
Pituitary adenoma is a benign round tumor in the brain. It is localized in the area of the sella turcica, near the base of the skull bones. WHO statistics state that adenoma accounts for 80% of all pituitary tumors. It occurs in 1 in 50,000 people, but due to the lack of comprehensive diagnostics, the actual numbers may be much higher.
A pituitary adenoma is a microformation that for a long time may not report itself with any obvious symptoms. It progresses slowly and can only be detected in the initial stages through a detailed diagnostic examination. Adenoma can occur at any age, but most often it affects people 30-60 years old. Rarely occurs in children.
Due to the long-term absence of any symptoms, pituitary adenoma can cause serious endocrine problems: hyperprolactinemia, obesity, Cushing's syndrome. Because of this benign tumor, the synthesis of hormones in the pituitary gland is suppressed, which disrupts the entire endocrine system. Also, the formation, which increases in size, compresses the adjacent brain tissue, causing migraines, epileptic seizures, decreased visual acuity and much more.
When should you see a doctor?
Pituitary adenoma is accompanied by endocrine disorders, which always cause negative symptoms. Be sure to make an appointment with your doctor if you experience weight loss or gain without changing your diet, blurred vision, changes in the appearance of the skin, headaches, or sexual dysfunction. You will be prescribed a series of tests, based on which a specialist will make an accurate diagnosis. The sooner you contact a medical clinic, the sooner you will receive a conclusion, the shorter and more effective the treatment will be.
First appointment with a therapist. Next, based on complaints and examination results, the specialist will write a referral to a specialized doctor. Women are examined by a gynecologist-endocrinologist, men by an andrologist. Consultations with doctors of other specializations may be required.
The MedCom clinic in Ryazan has everything necessary for the diagnosis and treatment of pituitary adenoma. Experienced doctors will conduct an emergency examination and develop the most effective and safe treatment regimen. Make an appointment by calling +7 (4912) 77–92–02 or using the online contact form. Do not delay your visit to the doctor - pituitary adenoma can be successfully treated in the early stages!
Prognosis and prevention
Pituitary adenoma is a benign brain tumor. However, as its size increases, it can take a malignant course: it begins to compress nearby brain tissue and its anatomical formations. Typically, after surgery, the patient’s hormonal levels are restored, and he gets rid of the symptoms of the disease. For adenomas whose diameter is more than 2 centimeters, there is a possibility of relapse. They usually occur within 5 years after the intervention.
The prognosis for pituitary adenoma depends on its type. With microcorticotropinomas, about 85% of patients completely restore endocrine functions. With prolactinomas and somatotropinomas, the probability of recovery is lower - about 20%. Such neoplasms require constant use of corrective medications.
There is no primary prevention for pituitary adenoma. Doctors have still not been able to determine the exact mechanism of development of the pathology. Secondary prevention consists of early diagnosis of the disease, regular blood donation for hormonal testing, and maintaining a healthy lifestyle. Every effort must be made to prevent head injury. If you suspect you have a pituitary adenoma or want to cure an existing disease, contact the Medscan medical center. Experienced doctors will be able to help you with this.
Treatment methods used
Standard treatment for pituitary adenoma consists of drug, radiation and neurosurgical therapies. The optimal method of exposure is determined based on the diagnostic results: it depends on the patient’s condition, the characteristics of the tumor itself, and the presence of concomitant diseases.
Drug therapy
Drug therapy is prescribed in 90% of cases. The drugs help get rid of the symptoms of the disease and improve the patient’s well-being. Initially, vitamin and restorative complexes are prescribed. Next, you need to determine the type of tumor:
- for prolactinomas, dopamine agonists or ergoline drugs are prescribed,
- for somatotropinomas - somatostatin agonists,
- for corticotropinoma - steroidogenesis blockers.
If necessary, hormone replacement therapy is performed. If the chosen treatment regimen does not bring results for a long time, then a more radical method of treatment is selected: radiation therapy or surgery.
Radiation therapy
For microadenomas, proton, gamma and remote therapy are used. The essence of the tactic is the introduction of a radioactive substance directly into the pathological area. Thanks to this effect, it is possible to stop the growth of the tumor and achieve regression. Typically, radiation therapy is performed when surgery is not possible and the patient refuses surgery. After such exposure, the pituitary adenoma gradually decreases in size and can be completely destroyed.
Surgical intervention
If the tumor is large and associated complications develop (hemorrhages, cyst formation, visual impairment), its removal using the transcranial method is indicated. The operation involves craniotomy. In some cases, intervention may be performed using endoscopic techniques.
The choice of specific treatment tactics mainly depends on the type of tumor. For prolactinoma, radiation exposure is practically useless, while for corticotropinoma it is highly effective. If the tumor does not cause any disturbances in the body and the patient does not complain of deterioration in health, doctors choose a wait-and-see approach.
Diagnostics
Comprehensive diagnostics is the basis for correct diagnosis. To determine the hormonal status, a blood test is prescribed with an assessment using the RIA method (radioimmune assessment of hormones). The analysis allows you to determine the level of pituitary tropic hormones.
MRI is the main diagnostic method used to detect pituitary adenomas of various sizes. Computed tomography is used less frequently and mainly in cases where it is necessary to visualize hard tissues, the walls of the sella turcica and formations that have spread beyond its boundaries.
CT angiography is one of the most important diagnostic methods performed before planned operations for the removal of large pituitary adenomas. The surgeon must know how the formation is located in relation to the cerebral arteries and optic nerve. Imaging protocols are used directly during surgery.
Dynamic contrast-enhanced magnetic resonance imaging is considered the most informative method for assessing small formations in the pituitary gland. Using a tomograph, you can determine the boundaries and size of the tumor, while ensuring high resolution resolution in the image.
