What Can I Expect During Pituitary Tumor Surgery?

Pituitary tumors can be classified according to tumor size and hormone secretion function. According to the size of the tumor, pituitary tumors are divided into pituitary adenomas (the diameter of the tumor is less than 1cm) and pituitary adenomas (the diameter of the tumor is greater than or equal to 1cm). According to the secretion of hormones, they can be divided into hormone-secreting pituitary tumors and nonfunctional adenomas. The size of pituitary tumors is closely related to the prognosis of treatment. About 70% of pituitary nonfunctioning tumors do not require treatment. If there is no corresponding decrease in pituitary function, clinical follow-up can be long-term. If the corresponding clinical symptoms appear during the follow-up process, the tumor grows faster, and the surrounding tissues (such as visual field defects) are compressed, surgical treatment can be considered.

Pituitary tumor

Classification of pituitary tumors

Pituitary tumors can be classified according to tumor size and hormone secretion function. According to the size of the tumor, pituitary tumors are divided into pituitary adenomas (the diameter of the tumor is less than 1 cm) and pituitary adenomas (the diameter of the tumor is 1 cm or more). According to the secretion of hormones, they can be divided into hormone-secreting pituitary tumors and nonfunctional adenomas. The size of pituitary tumors is closely related to the prognosis of treatment. About 70% of pituitary nonfunctioning tumors do not require treatment. If there is no corresponding decrease in pituitary function, clinical follow-up can be long-term. If the corresponding clinical symptoms appear during the follow-up process, the tumor grows faster, and the surrounding tissues (such as visual field defects) are compressed, surgical treatment can be considered.

Four types of hormone-secreting pituitary tumors

Hormone-secreting tumors are the pituitary tumors with the most complicated clinical manifestations, diverse treatment options, and clinical prognosis.

According to the type of hormone secretion, hormone-secreting pituitary tumors can be divided into the following types:

1) Prolactin-secreting pituitary tumor. Most are female patients, mainly manifested as amenorrhea, lactation, and infertility. Male patients are predominantly men with reduced sexual function, such as decreased sexual desire, impotence, and infertility.

2) Growth hormone secreting pituitary tumor. Mainly manifested as giant disease (occurring in young patients with epiphyseal closure), face changes, enlarged hands and feet (increased shoe size), hyperhidrosis, osteoarthropathy, carpal tunnel syndrome, swelling of the soft tissues and joints of the toes , Elevated blood pressure, elevated blood sugar, coronary heart disease, and tumors of the thyroid and colon.

3) ACTH secretory pituitary tumors. Mainly manifested as concentric obesity, full moon face, acne, hairy, purple lines (purple skin lines on the body).

4) Thyroid-stimulating hormone (TSH) secreting pituitary tumor. Mainly manifested as symptoms of high metabolism, such as fear of heat, sweating, weight loss, and atrial fibrillation.

5) Others include FSH and LH pituitary tumors. The main clinical manifestations are menstrual disorders and infertility in women, and the main manifestations of male sexual decline and infertility in men. Hormone-secreting tumors can occur alone, or they can be mixed tumors with increased secretion of two or more hormones. The clinical manifestations also have corresponding mixed symptoms.

Clinical manifestations of pituitary tumors

The pituitary gland is an important endocrine organ. It contains several endocrine cells and secretes a variety of endocrine hormones. If an endocrine cell grows an adenoma, special clinical manifestations can occur. The details are described as follows:

1. Endocrine manifestations of different types of pituitary adenomas

(1) Growth hormone cell adenoma: The early tumor is only a few millimeters in size, which is mainly manifested by excessive secretion of growth hormone. Underage patients can grow too fast and even develop into giants. Adults later show acromegaly. If the face changes, the forehead becomes larger, the jaw is protruding, the nose and lips are thicker, the fingers become thicker, the shoes and hats feel tight, and the larger models have to be replaced several times, and they must even be specially made. Some patients have increased meals and hair and skin Rough, pigmented, numb fingers, etc. In severe cases, they feel general weakness, headache, arthralgia, sexual decline, amenorrhea and infertility, and even diabetes.

(2) Prolactin cell adenoma: Mainly manifested as amenorrhea, galactorrhea, infertility, severe axillary hair loss, pale and delicate skin, increased subcutaneous fat, as well as fatigue, fatigue, lethargy, headache, and decreased sexual function. Males showed decreased libido, impotence, hyperplasia of mammary glands, scarce beards, severe reproductive organ atrophy, reduced sperm count, infertility, etc. Men and women did not change much.

(3) Adrenocorticotrophic adenoma: clinical manifestations include concentric body obesity, full moon face, buffalo back, multiple blood quality, purple skin on the thighs of the abdomen, and increased coat hair. Severe amenorrhea, loss of libido, general weakness, and even bedridden. Some patients do not have hypertension or diabetes.

(4) Thyroid stimulating hormone cell tumor: Rare, due to excessive secretion of pituitary thyroid stimulating hormone, causing hyperthyroidism symptoms, hyperthyroidism symptoms disappear after pituitary tumor removal. In addition, the feedback of hypothyroidism causes focal hyperplasia of the pituitary gland, which gradually develops into a pituitary adenoma. When it grows up, it can also cause the symptoms of the enlarged saddle and the compression of nearby tissues.

(5) Follicle-stimulating cell adenomas: very rare, with only few reports of clinical sexual dysfunction, amenorrhea, infertility, reduced sperm count, etc.

(6) Melanin-stimulating cell adenomas: Very rare, and only a few patients have reported dark skin and no cortisol increase.

(7) Endocrine inactive adenomas: Early patients with no special sensory tumors grow up, which can compress the clinical manifestations of pituitary insufficiency caused by the pituitary.

(8) Malignant pituitary tumor: short history and rapid progression of the disease, not only the tumor grows and oppresses the pituitary tissue, but also invades the surrounding area, causing bone damage to the saddle bottom or immersion in the cavernous sinus, causing paralysis of the oculomotor nerve or abduction of the abduction nerve. Sometimes the tumor penetrates the base of the saddle and reaches the sphenoid sinus, and neurological symptoms are not obvious for a short period of time.

2. Visual field disorders: Early pituitary adenomas often do not have visual field disturbances. If the tumor grows up, stretches upwards, and oppresses the optic cross, a visual field defect occurs, the outer upper quadrant is affected first, and the red visual field appears first. Later, when the lesions increase and the compression is severe, the white field of vision is also affected, and the defect can gradually expand to double temporal hemianopia. If it is not treated in time, the visual field defect can be enlarged again, and the vision is also reduced, so that it is completely blind. Because pituitary tumors are mostly benign, the initial lesions can last for a considerable period of time. When the disease is serious, the visual field of vision can suddenly increase. If the tumor is on one side, it can cause blindness or blindness in one eye.

3. Other neurological symptoms and signs: If pituitary tumors grow backwards and oppress the pituitary stem or hypothalamus, they can cause polydipsia and polyuria; if the tumors grow laterally and invade the cavernous sinus wall, oculomotor nerve or abductor nerve paralysis occurs If the tumor passes through the saddle septum and grows up, it causes the ventral part of the frontal lobe, and sometimes there are psychiatric symptoms; if the tumor grows upward and obstructs the third ventricle and the interventricular foramen, there will be symptoms of increased intracranial pressure such as headache and vomiting; The tumor grows backwards, which can compress the brainstem, cause coma, paralysis, or debilitating the brain.

Abnormal symptoms of pituitary tumors

Pituitary tumors are benign brain tumors, which are relatively common. How can you detect and treat them early? Let me introduce you in detail. The pituitary gland is an important endocrine organ. It contains several endocrine cells and secretes a variety of endocrine hormones. If an endocrine cell grows an adenoma, special clinical manifestations can occur.

1. Endocrine manifestations of different types of pituitary adenomas: (1) growth hormone cell adenoma: early tumors are only a few millimeters in size, mainly manifested as excessive secretion of growth hormone. (2) prolactin cell adenoma: mainly manifested as amenorrhea, galactorrhea, insufficiency In severe cases, shedding axillary hair, pale and delicate skin, and increased subcutaneous fat, as well as fatigue, tiredness, lethargy, headache, and decreased sexual function. Men are characterized by decreased libido, impotence, hyperplasia of breasts, rare beards, and reproduction in severe cases. Organ atrophy, decreased sperm count, infertility, etc., there are not many men and women. (3) Adrenocorticotrophic adenoma: clinical manifestations of body concentric obesity, full moon face, buffalo back, multiple blood quality, abdominal thighs There are purple lines on the skin and increased vellus hair, etc. In severe cases, amenorrhea, hyposexuality, general weakness, and even bedridden. Some patients have hypertension and diabetes. (4) Thyroid stimulating hormone cell tumor: rare, due to pituitary Excessive secretion of thyroid stimulating hormone, causing symptoms of hyperthyroidism, hyperthyroidism symptoms disappear after pituitary tumor removal. In addition, feedback of hypothyroidism caused focal hyperplasia of the pituitary gland, which gradually developed into pituitary Adenomas can also cause symptoms such as enlarged saddles and compression of nearby tissues when they grow up. (5) Follicle-stimulating hormone adenomas: Very rare, and only a few clinical reports of clinical sexual dysfunction, amenorrhea, infertility, and sperm count Decrease, etc. (6) Melanin-stimulating cell adenoma: very rare, only individual reports of patients with dark skin and no cortisol increase. (7) inactive endocrine function adenoma: early patients without special sensory tumor growth, but Clinical manifestations of hypopituitarism caused by compression of the pituitary.

2. Visual field of vision disorders: Early pituitary adenomas often have no visual field of vision. If the tumor grows, stretches upwards, and oppresses the intersection of vision, a visual field defect occurs, the outer upper quadrant is affected first, and the red field of vision appears first. Later the lesion increases, If the compression is severe, the white field of vision is also affected, and gradually the defect can expand to bilateral temporal blindness. If not treated in time, the visual field defect can be enlarged again, and the vision is also reduced, resulting in total blindness. Because pituitary tumors are mostly benign, the initial lesions can be For a considerable period of time, when the condition is severe, the visual field of vision can suddenly increase. If the tumor is to one side, it can cause blindness or blindness in one eye.

3 Other neurological symptoms and signs: If pituitary tumors grow backward and compress the pituitary stem or hypothalamus, they can cause polydipsia and polyuria; if the tumor grows laterally and invades the cavernous sinus wall, paralysis of the oculomotor nerve or abductor nerve occurs; if When the tumor passes through the saddle septum and grows up, the ventral part of the frontal lobe sometimes causes psychiatric symptoms. If the tumor grows upward and obstructs the front of the third ventricle and the interventricular foramen, there will be symptoms of increased intracranial pressure such as headache and vomiting. After the growth, it can compress the brain stem, cause coma, paralysis, or go to brain rigidity.