Pituitary Adenomas
Disorders in the pituitary gland, which is responsible for the production and secretion of many hormones in our body, can cause serious health problems. One of these problems is pituitary gland adenomas, which constitute approximately 10% of tumors encountered in the brain.
The pituitary gland is a gland located in the center of the brain that secretes important hormones for our body. The hormones released from this gland and their functions are as follows;
- Prolactin (Milk hormone)
- GH (Growth Hormone)
- ACTH (Salt and water balance and cortisone release)
- TSH (Thyroid Stimulating Hormone)
- FSH, LH (Sex hormones)
Pituitary gland adenomas are benign tumors. These tumors do not spread elsewhere, they are not cancer. There are two kinds of effects.
First, if the hormone secretes one or more of these hormones, symptoms due to hormone imbalance occur. For example, if prolactin (milk hormone) is secreted excessively, milk comes from the breasts in women and enlarged breasts in men. The most commonly affected hormone in adenomas is prolactin. If GH (growth hormone) is secreted excessively, growth is seen in the hands and feet, nose and internal organs such as the heart (acromegaly).
The second effect of pituitary adenoma is related to the compression of the surrounding tissues by the growing adenoma. Since it is the optic nerve closest to the pituitary gland, complaints about vision are most common. These complaints are mostly in the form of half vision loss in both eyes.
Diagnosis
With pituitary MRI, the relationship between adenoma and surrounding tissues can be clearly seen. Hormone tests in the blood and eye examination are other routine tests. In MRI, adenomas smaller than 1 cm are called microadenomas, and large ones are called macroadenomas.
Treatment
There are 4 steps in the management of these adenomas:
Monitoring: If the adenoma does not secrete any hormones and is smaller than 1 cm in the MRI taken, if it does not put pressure on the surrounding tissues (optic nerve), they are followed. Approximately 10% of all adenomas do not secrete hormones.
Drug Therapy: If the adenoma does not put pressure on the optic nerves (smaller than 1 cm) but secretes hormones, the appropriate drug is given to the hormone it secretes. For example, adenomas called prolactinoma respond very well to drug therapy.
Surgical Treatment: If the adenoma compresses the surrounding tissues, causes vision loss, or if the hormone it secretes is at a high level and does not respond adequately to drug treatment, the adenoma is surgically removed. For example, since the excess of growth hormone causes dysfunction in the internal organs, surgery is the first plan in these adenomas.
Surgical treatment was previously performed by microscopic method through the nostril, but today it is performed endoscopically through the nostril in the presence of experienced ENT doctors. The advantage of this is that the intranasal structures are not damaged, there is no need for nasal packing after surgery, it allows discharge in a shorter time and a wider removal of the adenoma.
In rare cases where the adenoma is excessively large and nasal removal is insufficient, open brain surgery (craniotomy) is required.
Gamma Knife: If a piece of adenoma remains in the area close to the shanger vessel (carotid) after the operation, a single session of radiation therapy called gamma knife can be applied. This treatment can be used as an alternative to surgery in some cases.