Pituitary gland is an important endocrine organ, which contains a variety of endocrine cells and secretes a variety of endocrine hormones. If an endocrine cell grows adenoma, it may have special clinical manifestations. The specific description is as follows:
1. endocrine manifestations of different pituitary adenomas
(1) Growth hormone cell adenoma: The early tumor is only a few millimeters in size, mainly showing excessive secretion of growth hormone. Juvenile patients may grow too fast and even develop into giants. Adults are manifestations of acromegaly. For example, the face has changed, the forehead has become bigger, the chin has become prominent, the nose has become thicker, the fingers have become thicker, and the shoes and hats feel tight. Older models have to be changed several times, and even they have to be specially customized. Some patients have increased appetite, rough hair and skin, pigmentation and numbness of fingers. In severe cases, people will feel general fatigue, headache and joint pain, sexual dysfunction, amenorrhea and infertility, and even diabetes.
(2) Prolactin cell adenoma: mainly manifested as amenorrhea, galactorrhea, infertility, serious cases of axillary alopecia, pale and tender skin, subcutaneous fat increase, fatigue, drowsiness, headache, sexual dysfunction, etc. Males are characterized by decreased libido, impotence, hyperplasia of mammary glands, sparse beard, severe cases of reproductive organ atrophy, decreased sperm count, infertility and so on. Few men and women have changed.
(3) Adrenocorticotropin cell adenoma: The clinical manifestations are centripetal obesity, full moon face, purple stripes on buffalo back, blood, abdomen and thigh skin, and increased mane. In severe cases, amenorrhea, decreased libido, general weakness and even bedridden. Some patients have hypertension and diabetes.
(4) Thyrotropin cell tumor: rare, because the pituitary gland secretes too much thyrotropin, the symptoms of hyperthyroidism will disappear after pituitary tumor resection. In addition, the feedback of hypothyroidism causes focal pituitary hyperplasia, which gradually develops into pituitary adenoma, and can also cause the symptoms of sella turcica enlargement and compression of nearby tissues when it grows up.
(5) Follicle-stimulating hormone cell adenoma: it is very rare, and only a few cases report clinical sexual dysfunction, amenorrhea, infertility, and decreased sperm count.
(6) Melanin-stimulating hormone cell adenoma: It is very rare, and only a few cases have reported melanotic patients without cortisol elevation.
(7) Adenoma with inactive endocrine function: Early patients have no special feeling that the tumor grows up, which can compress the pituitary gland and lead to clinical manifestations of pituitary dysfunction.
(8) Malignant pituitary tumor: short medical history and rapid progress. The tumor not only grows up and oppresses the pituitary tissue, but also invades all around, resulting in the destruction of sellar bone or immersion in cavernous sinus, causing oculomotor nerve paralysis or abducens nerve paralysis. Sometimes the tumor penetrates the sellar floor and reaches the sphenoid sinus, and the neurological symptoms are not obvious in a short time.
Pituitary tumor of brain
2. Visual field disturbance: Early pituitary adenoma often has no visual field disturbance. If the tumor grows up, stretches upward and compresses the chiasma, there will be visual field defect, which will first affect the outer upper quadrant and first show the red visual field. In the future, if the lesion becomes larger and the compression is heavier, the white visual field will also be affected, and the defect will gradually expand to bilateral temporal hemianopia. If not treated in time, the visual field defect can be enlarged again, and the vision will be reduced, resulting in complete blindness. Because pituitary adenomas are mostly benign, the initial lesions can last for a long time. When the condition is serious, the visual field disorder can suddenly increase. If the tumor is on one side, it can lead to blindness or blindness in one eye.
3. Other nervous system symptoms and signs: If pituitary adenoma grows backward and compresses pituitary stalk or hypothalamus, it can cause polydipsia and polyuria; If the tumor grows laterally and invades the wall of cavernous sinus, oculomotor nerve or abducens nerve paralysis will occur; If the tumor grows upward after passing through the sellar septum and causes the ventral part of the frontal lobe, sometimes mental symptoms will appear; If the tumor grows backward and upward, blocking the front of the third ventricle and the interventricular foramen, there will be symptoms of increased intracranial pressure such as headache and vomiting; If the tumor grows backward, it can compress the brain stem, leading to coma, paralysis or denervation.
Clinical manifestations of pituitary adenoma Pituitary adenoma mostly occurs in young adults aged from 20 to 50, especially in the elderly, especially children, and the incidence of male and female is roughly the same. Its clinical manifestations may appear as follows: 1 or above: 1. Headache. 2. Visual field changes (one eye or both eyes can't see clearly, so it is easy to bump into the door frame, and in severe cases, it gradually develops into blindness or sudden headache blindness) 3. Menstrual disorders, menopause, lactation (spontaneous breast-feeding or breast-feeding after touching the breast), infertility, sexual desire change (mostly decreased sexual ability), body hair reduction, and skin change (thinning) 4. Acromegaly:
accessory examination
How can we find pituitary adenoma early?
Pituitary tumor of brain
Attention should be paid to the related symptoms, such as a ct examination and a more detailed MRI examination. Generally speaking, if the endocrine changes are obvious, the treatment is ineffective, or there are headaches, visual impairment, endocrine and other conditions, any one should be considered. If they appear at the same time, check them in time. Pituitary tumors generally occur in women aged 20-40, because there are many hormonal changes and fluctuations in female sexual life.
1. Endocrine examination: The direct determination of pituitary growth hormone, prolactin, adrenocorticotropic hormone, thyrotropin, melanotropin, follicle stimulating hormone and luteinizing hormone by endocrine radioimmunoassay is very helpful for the early diagnosis of pituitary adenoma.
2. Radiological examination
(1) Saddle image: It is one of the basic exams. When the pituitary tumor is very small, the sella turcica can remain unchanged. As the tumor grows up day by day, it can cause sella turcica enlargement, bone destruction and erosion of sella turcica.
(2)ct scan: Pituitary adenoma with a size of 5mm can be displayed after intravenous contrast agent enhancement. It is still difficult to show smaller tumors.
Treatment measures
1. Surgical treatment: mainly including craniotomy and transsphenoidal surgery.
Pituitary tumor of brain
2. Radiotherapy: General radiotherapy has a certain effect on pituitary adenoma, which can only control the development of the tumor, sometimes shrink the tumor and improve the visual field, but it can't be cured fundamentally; Only gamma knife treatment of the head is the radical cure for pituitary adenoma. Gamma knife radiosurgery for pituitary adenoma has good curative effect, less pain and less reaction. After half a year of treatment, the tumor will gradually shrink, and abnormal hormone changes will gradually return to normal. Gamma knife is non-invasive and is the first choice for smaller tumors.
3. Drug therapy: bromocriptine is a semi-synthetic ergotamine alkaloid, which can stimulate dopamine receptors in pituitary cells and reduce the role of prolactin in blood. Taking bromocriptine can shrink prolactin adenoma, restore menstruation and ovulation, and inhibit pathological galactorrhea. However, bromocriptine can't cure prolactinoma fundamentally, but it can continue to increase after stopping taking the drug and the symptoms reappear. In addition, bromocriptine can also relieve the symptoms of growth hormone cell adenoma, but the dosage is large and the curative effect is poor. harm
Pituitary tumors cause vision loss.
Pituitary tumor can break through the base of sella turcica and grow downward, invading important intracranial vessels and nerves on both sides. However, the most common growth mode is to develop to sella turcica, which compresses the chiasma and optic nerve, resulting in decreased vision and visual field defect. Patients often complain that their eyesight is declining, they can't see clearly on both sides, and they always bump into the door. If there is visual field disorder, it is necessary to operate as soon as possible to relieve the oppression on the optic nerve and save vision. If it is accompanied by growth in other directions, it is called invasive pituitary adenoma, which is obviously more difficult to treat and difficult to remove at one time, so individualized treatment is needed according to the specific situation.
classify
Pituitary tumors can be classified according to the size of tumors and the function of hormone secretion. According to the size of tumor, pituitary adenoma can be divided into pituitary microadenoma (tumor diameter less than 1cm) and pituitary adenoma (tumor diameter greater than or equal to 1cm). According to the difference of hormone secretion, it can be divided into pituitary adenoma and nonfunctional adenoma. The size of pituitary adenoma is closely related to the prognosis of treatment. About 70% of pituitary nonfunctional tumors do not need treatment. If there is no corresponding pituitary hypofunction, it can be followed up for a long time in clinic. If the corresponding clinical symptoms appear in the follow-up process, the tumor grows faster and oppresses the surrounding tissues (such as visual field defect). ), you can consider surgery.
Four types of hormone-secreting pituitary adenomas
Hormone-secreting tumor is one of pituitary tumors with the most complicated clinical manifestations, diverse treatment schemes and different clinical prognosis.
According to the different types of hormone secretion, pituitary adenomas secreting hormones can be divided into the following categories:
1) prolactin-secreting pituitary adenoma. Most of them are female patients, mainly manifested as amenorrhea, lactation and infertility. Male patients mainly show low sexual function, such as decreased libido, impotence, infertility and so on.
2) Growth hormone secreting pituitary adenoma. The main manifestations are gigantism (occurring in adolescent patients with epiphysis not closed), facial changes, stout hands and feet (increasing the size of shoes), hyperhidrosis, osteoarthrosis, carpal tunnel syndrome, swelling of soft tissues and joints of hands and feet (toes), elevated blood pressure, elevated blood sugar, coronary heart disease, thyroid and colon tumors, etc.
3) Pituitary adenoma secreting adrenocorticotropic hormone (acth). The main manifestations are centripetal obesity, full moon face, acne, hirsutism and purple dermatoglyphics (purple dermatoglyphics on the body).
4) Pituitary adenoma secreting thyroid stimulating hormone (tsh). The main symptoms of hypermetabolism are fear of heat, sweating, weight loss, palpitation and atrial fibrillation.
5) Other pituitary adenomas are fsh and lh. The main clinical manifestations are menstrual disorder and infertility in women, sexual dysfunction and infertility in men. Hormone-secreting tumors can occur alone or be mixed tumors with increased secretion of two or more hormones, and their clinical manifestations also have corresponding mixed symptoms.
diagnose
The diagnosis of pituitary adenoma is mainly based on the corresponding clinical symptoms, signs, pituitary hormone detection and imaging examination.
Pituitary hormones have been detected in many laboratories, even in primary hospitals. However, in the process of clinical diagnosis and treatment, we often rely too much on laboratory examination and ignore the special requirements of pituitary hormone secretion rhythm for blood collection time, which leads to the inability to judge the hormone determination results of many patients.
Among the hormones secreted by pituitary gland, gh, acth and prl have obvious circadian rhythm and are all stress hormones. The clinical blood collection time of gh and acth should be 8am (fasting), and they should rest in a quiet state for more than half an hour before blood collection. The measurement of blood prl should be between 10am ~ 2pm, and the measured prl results are trough, so the measured value can reflect the serum prl level of patients in non-stress state.
Imaging examination is a very important means to diagnose pituitary adenoma. Among them, magnetic resonance imaging in sellar region has the highest detection rate of pituitary adenoma. Through mri detection of thin-layer enhanced images of sellar region (scanning one layer every 65438±0mm), pituitary microadenomas as small as 2-3mm in diameter can also be imaged if combined with dynamic enhanced mri detection. Contrast-enhanced ct imaging in sellar region has a good imaging effect on some pituitary macroadenomas, and can understand the degree of bone destruction in sellar floor and the degree of sphenoid sinus gasification.
Through detailed clinical consultation, physical examination, determination of pituitary hormones and imaging examination, the diagnosis of pituitary adenoma is not difficult to determine.