Pituitary adenoma

Pituitary adenoma and endonasal endoscopy

THEpituitary adenoma it's a benign tumor, that hits the pituitary and in particular its anterior part (adenohypophysis). No precise risk factors have been ascertained, except for familiarity. To understand the possible consequences, it is worth knowing the role of the pituitary gland in our body.

Pituitary adenoma is usually treated surgically by endonosal endoscopy.

What is the pituitary gland used for?

THEpituitary gland is a endocrine gland small in size: it measures less than 1 centimeter in diameter. It is located inside the skull and contained in a bony saddle ("sella turcica"), located behind the nose and between the eyes. It consists of two sections, one anterior (adenohypophysis) and one posterior (neurohypophysis).

Although its structure suggests an unremarkable gland, the pituitary is actually the equivalent of an orchestra conductor: The hormones it secretes in turn stimulate the activity of other glands, thus affecting the regulation of the metabolism of our body, its growth and reproduction.

For this reason, if one of the pituitary hormone lines is affected by a particular disorder, potentially very serious pathologies can result. The pituitary gland can in fact be affected by various types of lesions, mostly benign, of which pituitary adenoma is the most common.

The types of pituitary adenoma

When a pituitary adenoma forms, we witness the abnormal development of part of the pituitary and its cells. It can secrete hormones (secreting) or not (non-secreting). Below a diameter of 1 centimeter, we speak of pituitary microadenoma; exceeded the centimeter, it is about pituitary macroadenoma. Size, location and secreting state or not determine the possible consequences:

  • hypersecretion syndrome: occurs when the adenoma produces too many hormones (TSH, prolactin, ACTH, growth hormone). This causes a significant imbalance in the body, leading to diseases such as Cushing's disease (manifested by excessive amounts of fat along the entire trunk and face), acromegaly (overgrowth of some bone structures), prolactinoma (cancer that negatively affects fertility in both men and women)
  • insufficiency syndrome, which sees the adenoma invade the space occupied by the pituitary and hinder its normal functioning. There is thus a decrease in the production of hormones (hypopituitarism)
  • mass syndrome: the size of the adenoma ends up causing compression of the optic nerves, resulting in loss of visual acuity or reduction of the lateral visual field

Pituitary adenoma and symptoms

It is not taken for granted that the pituitary adenoma manifests itself with recognizable symptoms: on the contrary, it is possible that it is identified by chance, during diagnostic tests performed for other reasons. 

The most common symptoms, especially in the case of macroadenoma, include: headache, blurred vision, visual field alteration. In the case of particularly invasive macroadenoma, they can also occur disorientation, vomiting, drowsiness, bulimia and diabetes insipidus (which is not related to sugar metabolism, but to the lack of the hormone vasopressin). 

Other symptoms, due to the loss of function by the pituitary, can be menstrual problems and breast discharge in women, changes in the face, hands and feet, hypertension, decreased libido, both female and male infertility, sweating, increased hairiness , gigantism in children or adolescents, skin fragility, stretch marks, osteoporosis. 

The fundamental figures for the treatment of a pituitary adenoma

As mentioned, the diagnosis of pituitary adenoma is not simple. The patient must explain his symptoms and the possible presence in the family of similar cases as strictly as possible. Based on the data, the doctor can prescribe blood and urine tests to analyze hormone levels and afterwards a CT scan and an MRI to detect any injuries. If the symptoms also involve the visual field, a vision assessment exam.

Addressing this pathology is therefore a team play, in which each subject involved is essential:

- the patient, which is always at the center of the whole process with its personal and clinical history

- the doctor which has an important coordinating role

- L 'endocrinologist, contact person for diagnosis, control and treatment of the disease

- the neuroradiologist, expert in the diagnostic study of the nervous system

- L 'oculist, reference point for screening, diagnosis and control of ocular disorders

- the neurosurgeon, which treats the pathology through surgical excision

Treatment of pituitary adenoma: surgery

Therapy involves surgery in most cases, with the exception of small adenomas secreting prolactin or growth hormone, which can be treated with specific drugs. The evolution of technology and skills in this field has made a type of intervention possible minimally invasive very effective: the transphenoidal transnasal endoscopic surgery.

Pituitary adenoma and endonasal endoscopy

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Senior Consultant Neurosurgeon, specialist in Cerebral, Vertebral minimally invasive and pediatric surgery, at the Maria Cecilia Hospital in Cotignola, the Piccole Figlie Hospital in Parma and the Domus Nova in Ravenna, highly specialized hospitals, accredited by the NHS and affiliated with most of the international insurance circuits .

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Studies: Milan, Rome, Naples, Caserta, Bari, Mola di Bari, Domegge di Cadore, Ravenna, Castrocaro Terme, Fermo.

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