Treatment and Types of Pituitary Disease | Endocrinology

Pituitary Disease

What is a pituitary disease?

Pituitary diseases (pituitary tumors) are abnormal growths that progress on your pituitary gland. Some pituitary tumors make too many hormones that regulate important functions in your body. Some pituitary tumors can cause your pituitary gland to make lower levels of hormones.

Most pituitary tumors are noncancerous (benign) growths (adenomas). Adenomas remain in the pituitary gland or nearby tissues and do not spread to other portions of your body.

There are several options for treating pituitary tumors, including eliminating the tumor, controlling its growth, and management its hormone levels with medications. Your physician may recommend observation or a “wait and see” attitude.

Symptoms of pituitary disease

Not all pituitary diseases cause symptoms. Hormone-producing (working) pituitary diseases can cause a variety of signs and symptoms depending on the hormone they make. The signs and symptoms of pituitary tumors that do not produce hormones (that do not work) are connected to their growth and the pressure they put on other structures.

Large pituitary diseases, those that are about 1 centimeter (a little less than half an inch) or greater, are known as macroadenomas. The smallest tumors are called microadenomas. Unpaid to the size of macroadenomas, they can put heaviness on the normal pituitary gland and nearby structures.

Signs and symptoms related to tumor pressure:

Signs and symptoms of pressure from a pituitary disease can include:

  • Headache
  • Loss of vision, particularly the loss of peripheral vision

Symptoms related to changes in hormone levels:

Working too much: Functional pituitary diseases cause an overproduction of hormones. The different types of functional tumors in your pituitary gland cause specific signs and symptoms, and sometimes a combination of them.

Deficiency: Large tumors can cause hormone deficiencies. Signs and symptoms include:

  • Nausea and vomiting
  • Weakness
  • I am cold
  • Less frequent or no menstrual periods
  • Sexual dysfunction
  • The increased amount of urine
  • Unintentional weight loss or gain

Adrenocorticotropic hormone (ACTH) secreting tumors: ACTH tumors produce the hormone adrenocorticotropin, which stimulates the adrenal glands to produce the hormone cortisol. Cushing’s syndrome is the result of the adrenal glands making too much cortisol. Possible signs and symptoms of Cushing’s syndrome include:

  • Fat accumulation everywhere the waist and upper back
  • Exaggerated facial roundness
  • Thinning of the arms and legs with muscle weakness
  • Hypertension
  • High blood sugar level
  • Acne
  • Bone weakening
  • Bruises
  • Stretch marks
  • Anxiety, irritability, or depression

Growth hormone-secreting tumors: These tumors produce excess development hormone (acromegaly), which can cause:

  • Coarse facial features
  • Enlarged hands and feet
  • Excessive sweating
  • High blood sugar level
  • Heart problems
  • Pain in the joints
  • Misaligned teeth
  • Increased body hair

Children and adolescents can grow too fast or too tall:

Prolactin-secreting tumors: Overproduction of prolactin from pituitary diseases (prolactinoma) can cause a decrease in normal stages of sex hormones, estrogen in women, and testosterone in men. Excess prolactin in the blood affects men and women differently.

In women, prolactinoma can cause:

  • Irregular menstrual periods
  • Lack of menstrual periods
  • Milky discharge from the breasts

In men, a prolactin-producing tumor can cause male hypogonadism. Signs and symptoms can include:

  • Erectile dysfunction
  • Reduced sperm count
  • Loss of sexual desire
  • Breast growth

Thyroid-stimulating hormone-secreting tumors: When a pituitary disease overproduces thyroid-stimulating hormone, your thyroid gland produces too much thyroxine hormone. This is a rare source of hyperthyroidism or overactive thyroid disease. Hyperthyroidism can speed up your body’s metabolism, causing:

  • Weightloss
  • Fast or irregular heartbeat
  • Nervousness or irritability
  • Frequent bowel movements
  • Excessive sweating

Types of pituitary diseases

  • Non-functional adenomas
  • Functional adenomas
  • Pituitary carcinoma or cancer

Causes of pituitary disease

The cause of unrestrained cell growth in the pituitary gland, which generates a tumor, remains unknown. The pituitary gland is a small, bean-shaped gland situated at the base of your brain, a little behind your nose, and among your ears. Despite its small size, the gland influences almost every part of your body. The hormones it produces help adjust important functions, such as growth, blood pressure, and reproduction.

Risk factors of pituitary disease

People with a family history of certain inherited conditions, such as multiple endocrine neoplasias, type 1 (MEN 1), are at increased risk of developing pituitary diseases. In MEN I, numerous tumors occur in various glands of the endocrine system. Genetic tests are available for this disorder.

Diagnosis of pituitary diseases

pituitary diseases often go undiagnosed because their symptoms resemble other conditions. And some pituitary diseases are found due to medical tests for other conditions.

To diagnose a pituitary disease, your registrar will likely take a detailed history and achieve a physical exam. He or she could order:

  • Blood and urine tests: These tests can determine if you have an overproduction or deficiency of hormones.
  • Mental image: A CT or MRI scan of your brain can help your physician judge the position and size of pituitary disease.
  • Vision test: This can determine if a pituitary disease has affected your sight or peripheral vision.

Treatment for pituitary disease

Many pituitary diseases do not require treatment. Treatment for those who do depends on the type of tumor, its size, and how much it has grown in your brain. Your age and your overall health are also factors.

Treatment includes a team of medical experts, perhaps including a neurosurgeon, an endocrine system specialist (endocrinologist), and a radiation oncologist. Doctors normally use surgery, radiation therapy, and medications, either unaided or in combination, to treat a pituitary disease and return hormone production to normal levels.

Surgery

Transsphenoidal Transnasal Endoscopic Surgery Open Popup Dialog. Surgical removal of a pituitary disease is usually necessary if the tumor is pressing on the optic nerves or if the tumor is overproducing certain hormones. The success of the surgery depends on the type of tumor, its location, its size, and whether the tumor has invaded the surrounding tissues.  The two main surgical techniques for treating pituitary diseases are:

  • Transsphenoidal transnasal endoscopic approach: This usually allows your doctor to remove the tumor through the nose and sinuses without an external incision. No other part of your brain is affected and there is no visible scar. Large tumors can be difficult to remove in this way, especially if a tumor has invaded nearby nerves or brain tissue.
  • Transcranial approach (craniotomy): The tumor is removed through the top of the skull through an incision in the scalp. It is easier to reach large or more complicated tumors with this procedure.

Radiotherapy

Radiation therapy uses high-energy radiation sources to destroy tumors. It can be used after surgery or only if surgery is not an option. Radiation therapy may be beneficial if a tumor persists or reappears after surgery and causes signs and symptoms that medications do not relieve. Radiation therapy methods include:

  • Stereotactic radiosurgery: Often given as a single high dose, it focuses the radiation beams on the tumor without an incision. It applies radiation beams the size and shape of the tumor onto the tumor with the help of special imaging techniques of the brain. Minimal radiation comes into contact with healthy tissue around the tumor, reducing the risk of damage to normal tissue.
  • External beam radiation: This emits radiation in small increments over time. A series of treatments are performed, usually five times a week for a period of four to six weeks, on an outpatient basis. While this therapy is usually effective, it can take years to fully control tumor growth and hormone production. Radiation therapy can also damage the remaining normal pituitary cells and normal brain tissue, particularly near the pituitary gland.
  • Intensity-modulated radiation therapy (IMRT): This type of radiation therapy uses a computer that allows the doctor to shape the rays and surround the tumor from many different angles. The strength of the rays can also be limited, which means that the surrounding tissues will receive less radiation.
  • Proton beam therapy: Another radiation option, this type uses positively charged ions (protons) instead of X-rays. Unlike X-rays, beams of protons stop after releasing their energy within their target. The rays can be precisely controlled and can be used in tumors with less risk to healthy tissues. This type of therapy requires special equipment and is not widely available.

The benefits and complications of these forms of radiation therapy are often not immediate and can take months or years to be fully effective. A radiation oncologist will appraise your condition and debate the pros and cons of each option with you.

Medicines

Drug treatment can help block unnecessary hormone secretion and sometimes contract certain types of pituitary diseases:

Prolactin-secreting tumors (prolactinomas): The drugs cabergoline and bromocriptine (Parlodel) decrease prolactin emission and habitually shrink the tumor. Possible side effects include drowsiness, dizziness, nausea, nasal congestion, vomiting, diarrhea or constipation, confusion, and depression. Some people develop obsessive behaviors, such as betting, while taking these medications.

ACTH-producing tumors (Cushing’s syndrome). Mifepristone (korlym, Mifeprex) is approved for people with Cushing syndrome who have type 2 diabetes or impaired glucose tolerance. Mifepristone does not decrease cortisol production, but it does block the effects of cortisol in your tissues. Side effects can include fatigue, nausea, vomiting, headaches, muscle aches, high blood pressure, low potassium levels, and bloating.

Growth hormone-secreting tumors: There are two types of medications available for these types of pituitary tumors, and they are especially helpful if surgery has not been successful in normalizing growth hormone production. The first type of medicine is somatostatin equivalents, which include drugs such as octreotide (Sandostatin) and lanreotide (tomatine Depot), which causes a reduction in growth hormone production and can shrink the tumor. These are given by injections, commonly every four weeks.

These medications can cause side effects such as nausea, vomiting, diarrhea, stomach pain, dizziness, headache, and pain at the injection site. Many of these lateral effects recover or even go away with time. They can also cause gallstones and make diabetes mellitus worse diabetes mellitus.

The second type of medicine, pegvisomant (Somavert), blocks the effect of extra growth hormone in the body. This medicine, given by daily injections, can cause liver damage in some people.

Pituitary hormone replacement: If a pituitary tumor or surgery to remove it reductions hormone production, you may need to take additional hormones to maintain normal hormone levels. Some people who receive radiation therapy also need pituitary hormone replacement.

Wait attentively: Watchful waiting, also known as observation, watchful waiting, or delayed therapy, you may need regular follow-up tests to see if your tumor is growing. This might be an option if your tumor is not causing signs or symptoms.

Many people with pituitary tumors function normally without treatment if the tumor is not causing other problems. If you are younger, attentive waiting may be an option as long as you accept the possibility that your tumor will transform or grow during the observation period, possibly requiring treatment. You and your doctor can weigh the risk of symptoms versus treatment.

Complications of pituitary disease

pituitary diseases usually do not grow or spread widely. However, they can affect your health, possibly causing:

  • Sight loss: A pituitary disease can put heaviness on the optic nerves.
  • Permanent hormonal deficiency: The attendance of a pituitary disease or the removal of one can eternally alter your supply of hormones, which may need to be replaced with hormonal medications.

A rare but potentially serious problem of a pituitary disease is pituitary apoplexy when there is sudden bleeding into the tumor. It feels like the most simple headache you’ve ever had. Pituitary apoplexy needs emergency treatment, typically with corticosteroids and possibly surgery.

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