Pituitary tumors: What you need to know

Posted by Specialist Doctor II Nguyen Xuan Thang - Deputy Head of Internal Medicine Department and Head of Internal Medicine Unit - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

Pituitary adenomas are abnormal growths that develop in the pituitary gland. Pituitary tumors are among the most common endocrine tumors, second only to thyroid tumors. Pituitary tumors account for about 10% of brain tumors.

The pituitary gland is a small bean-shaped gland located at the base of the brain, slightly behind the nose and between the ears. Despite its small size, the gland affects nearly every part of the body. The hormones it produces help regulate important functions, such as growth and reproduction.
Pituitary adenomas are abnormal growths that develop in the pituitary gland. Pituitary tumors are among the most common endocrine tumors, second only to thyroid tumors. Pituitary tumors account for about 10% of brain tumors. Accordingly, pituitary tumors can be classified:
Benign or malignant Non-secreting or hormone-secreting. Size: small (<10mm in diameter), large (≥10mm) The vast majority of pituitary tumors are benign tumors. The most common primary tumor is a pituitary adenoma, which is usually benign, arising from cells of the anterior pituitary gland. An adenoma is usually confined to the pituitary gland or surrounding tissues without spreading to other parts of the body.

Pituitary tumors arise due to the following causes:
Proliferation of a pituitary cell line. Mutations in oncogenes or tumor suppressor genes are mostly malignant but rare. Some other mutations associated with pituitary adenomas such as activating gene mutations, encountered in 40% of GH-secreting adenomas, point mutations in the alpha subunit of G protein increase cyclic AMP, thus increasing cyclic AMP. GH secretion and cell proliferation, H-ras gene mutations have been identified in metastatic pituitary cancers. The pituitary tumor mutation gene is found in most pituitary tumors, especially prolactin-secreting tumors. In addition, autologous mutations, hypothalamic factors can stimulate and sustain the growth of transformed adenoma cells. At present, there are opinions about the fibroblast growth factor system, dysregulation of cell turnover control proteins, and loss of reticulin network, which play an important role in pituitary tumor formation.

The pituitary gland has many different types of glandular cells, each type of gland secretes a corresponding hormone (hormone) and affects other organs or endocrine glands of the body. There are many types of pituitary adenomas, but they can be divided into two main groups: hypersecreting pituitary tumors and non-hypersecreting pituitary tumors. Hypersecretory pituitary tumors are pituitary tumors that arise from hormone-secreting cells. The hormone-secreting cells of the pituitary gland develop into tumors, secreting too much hormone in the blood. These hormones affect other organs or endocrine systems of the body and disrupt their functioning.

Symptoms of a pituitary tumor depend on the size of the tumor and the hormone-secreting or non-secreting nature.

Headache, vomiting: common, not proportional to tumor size. Upward compression and compression on the optic nerve can cause bilateral temporal hemiparesis, red blindness, multiple dark spots, and total blindness. Lateral invasion can reach the sphenoid sinus and injure cranial nerves III, IV, VI, and V1, causing diplopia, ptosis, ophthalmoplegia, and some facial nerves. Seizures, somatic disturbances, and loss of smell may be present if the temporal and frontal lobes are invaded by development of a parapituitary mass. If infarction or bleeding occurs within the tumor, a sudden exacerbation of the disease may occur (pituitary ischemia).

Prolactin-secreting tumors account for about 25% of pituitary tumors. There are symptoms of increased prolactin blood levels: amenorrhea and lactation in women, decreased libido and erectile dysfunction in men. Growth hormone-secreting tumors account for about 15% of pituitary tumors. Depending on the time of onset of the disease before or after adulthood, acromegaly or gigantism is caused with the following symptoms: acromegaly, large face, wide forehead, protruding forehead, wide chin, and lips. thick, coarse skin, large feet and toes, large hands and fingers... ACTH-secreting tumors account for about 15% of pituitary tumors. Patients often have signs of weight gain, stretch marks on the abdomen, thighs, arms... flat muscles, big belly, small limbs. TSH-secreting tumors account for about 1% of pituitary tumors. Manifestations of thyroid hyperfunction (palpitations, palpitations, arrhythmias, weight loss, tremors ..) and large goiter. Gonadotropin-secreting pituitary tumors account for about 10% of pituitary tumors. Increases secretion of FSH and less commonly LH. Patients have symptoms of hypogonadism due to decreased regulation of gonadal function. Hyperthyroidism accounts for about 15% of pituitary tumors, which, in addition to elevated GH and prolactin, are often associated with acromegaly and hyperthyroidism. Non-hormone-secreting cell tumors account for about 20% of pituitary tumors, with no histological, immunological, or electron microscopic markers of hormone secretion.

The tumor does not secrete but causes direct compression of the pituitary gland or disconnection between the hypothalamus and the pituitary gland in the pituitary stalk. Manifested by total or partial hypopituitarism, especially secondary hypogonadism (amenorrhea, decreased libido, infertility,...), secondary hypothyroidism, hypothyroidism secondary adrenal cortex.
Congenital hypopituitarism or disease appearing in childhood will cause severe disorders of the thyroid gland, gonads, adrenal glands, development and water balance. Decreased secretion of ACTH causes hypotension, shock, hypoglycemia, nausea, fatigue, hyponatremia. It is necessary to measure cortisol and ACTH before prescribing glucocorticoids. Sexual dysfunction: women often have menstrual irregularities or amenorrhea, LH or FSH levels do not increase; Men with symptoms of sexual dysfunction and low testosterone. Sex hormone replacement therapy is important to prevent osteoporosis.

Some pituitary tumors do not secrete hormones such as:
Pituitary cysts / parasella cysts Rathke cysts (Rathke′s cleft cyts) Chordomas Germinomas ) Dermoid tumors Metastasis to pituitary Aneurysms Pituitary granulomas: Tuberculous meningitis, sarcoidosis, giant cell granuloma (Granulomatous hypophysitis) , histiocytosis X (HX), lymphocytic pituitary inflammation (lymphocytic hypophysitis), pituitary abscess, bleeding and infarction in the pituitary gland, pituitary carcinomas, pituitary hyperplasia, primary central nevous system lymphoma, pituitary apoplexy

Imaging: A brain magnetic resonance imaging (MRI) scan or computed tomography (CT) scan can help your doctor assess the location and size of a pituitary tumor. Tests: Tests to determine if there is an excess or deficiency of hormones. Eye exam : Check the degree of visual impact of pituitary tumor

Treatment for a pituitary tumor depends on the type of tumor, its size, and the degree of influence of the hormones. The main methods are surgery, radiation therapy and medical treatment. The treatment team includes a neurosurgeon, an endocrinologist, and an endocrinologist to remove the effects of the tumor and keep hormone levels normal.

MRI scan to monitor tumor progression, possibly every two years, if there are no signs of growth. Surgery is indicated when the tumor is large and tends to grow.
If the lesion is asymptomatic, the MRI should be repeated every 6 months to 1 year, then annually. Surgery may be delayed, unless there are signs of tumor growth.
If there are symptoms of compression on the optic nerve, invasion into the cavernous sinus, or pituitary dysfunction, surgery will be performed and radiation therapy should be considered (especially gamma knife, radiation therapy). rays from outside). 10% of bromocriptine-responsive tumors reduce tumor size

Prolactin-secreting tumors Treat with dopamine receptor antagonists.
GH-secreting tumors - Acromegaly Transsphenoid surgery is the method of choice, 70% of patients have GH levels < 5ng/mL and IGF levels are normal, but 5-10% recur. After conventional radiation therapy, 40% of patients achieve GH concentrations < 5 ng/mL at 5 years, and 60-70% at 10 years.
Cushing's disease Transsphenoidal surgery applies to 80-90% of patients. With a 5-10% recurrence rate, the hypothalamic-pituitary-adrenal axis can be suppressed for up to 1 year. Radiation therapy is indicated for non-surgical patients, patients with bilateral adrenalectomy or Nelson's syndrome. 61% of patients got relief in 12 months, 70% got 24 months.
TSH secretory Tumor Transsphenoid surgery, but less effective. Most patients respond well to octreotide acetate (sandostatin) which shrinks the tumor. Radiation therapy is optional when surgery is not possible. Treatment with hyperthyroid drugs is the same as treatment for other cases of hyperthyroidism.
Hope the above information helps you better understand pituitary tumors. Accordingly, you should seek medical attention immediately if you notice signs and symptoms that are similar to pituitary tumors or if there is a family member with pituitary adenoma. Because the location and medical condition can be different in each person, it is necessary to discuss with a doctor to determine the method of diagnosis, treatment and treatment.

Periodic health check-ups help to detect early conditions as well as pathologies of the pituitary gland and endocrine glands, thereby having a treatment plan to achieve optimal results. Currently, Vinmec International General Hospital has general health checkup packages suitable for each age, gender and individual needs of customers with a reasonable price policy, including:
Health checkup package general Vip Standard general health checkup package Patient's examination results will be returned to your home. After receiving the results of the general health examination, if you detect pituitary diseases, you can use services from other specialties such as testing, imaging, .. right at the Hospital with superior quality of treatment and customer service.

In April & May 2021, when there is a need for examination and treatment of pituitary tumor at Vinmec Central Park International General Hospital, customers will enjoy double incentives:
- Free specialist examination
- 50% discount for customers with post-examination treatment indications. The program is limited to the corresponding technique of each hospital and to customers who perform this treatment technique for the first time at Vinmec.