Pituitary Adenoma - Medical Malpractice Lawyer
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Pituitary Adenoma Overview
A pituitary adenoma is a tumor located in the pituitary gland in the brain. It tends to be a slow growing tumor and is almost always benign. It comes from one of the various cell types in the pituitary gland, which is a small, peanut-sized gland. The biggest problem with a pituitary adenoma is that it can cause problems with the hormones secreted by the pituitary gland. The adenoma can produce pituitary hormones or can produce no hormones at all but can interfere with the ability of the rest of the pituitary gland to make hormones. Large pituitary tumors are called macroadenomas and give patients visual dysfunction, headache, changes in energy, loss of sexual function, loss of libido, and a variety of other widely divergent symptoms.
Why do pituitary adenomas happen in the first place? No one knows the exact cause of specific pituitary adenomas but research has shown that changes or random mutations in the DNA of certain cells cause the adenoma to occur. Some congenital syndromes will show up as having pituitary adenomas as part of the diseases. Some genes become dysfunctional in patients who are otherwise normal.
What are the signs and symptoms of pituitary adenomas? It all depends on the location of the adenoma, its size and what hormone it produces, if any. For example, in nonfunctional macroadenomas, patients have visual loss, headache and insufficiency of all of the pituitary hormones. These are usually treated by surgical means but can be incidentally found during a CT scan or MRI scan for other reasons.
Prolactinomas are other common tumors of the pituitary gland. It usually presents itself in women who have irregular periods, secretion of breast milk, weight changes, and infertility. If men have it, they often get sexual dysfunction, weight changes and low sex drive.
Cushing’s disease is caused from a pituitary adenoma that secretes ACTH. This results in effects on the adrenal glands along with symptoms of weight gain, changes in body hair, scalp hair loss, changes in the skin and mood or anxiety problems.
Acromegaly results from a patient who has a pituitary tumor that secretes growth hormone. When it happens in adults, you get acromegaly; when it happens in children, you get gigantism. Adults will show changes in facial shape and in their axial skeleton. The jaw becomes misaligned, the tongue gets thick and the forehead becomes prominent. The changes grow slowly over time. Patients with the disease get high blood pressure, sleep apnea, diabetes and heart disease.
Some pituitary adenomas can cause high thyroid function and others go on to become malignant. These need to be treated urgently.
Pituitary adenomas can be diagnosed in several different ways. If they produce hormones or interfere with the way the normal part of the pituitary is making proteins, a blood test can help identify that a probable pituitary adenoma is occurring. For example, a prolactinoma will show up as having high prolactin levels. Non-secreting large tumors can show a low production of several pituitary hormones. If these patterns are suspicious for a pituitary adenoma then a CT scan of the head or MRI of the head can show definitively that a tumor is present.
The treatment of pituitary adenomas includes watchful waiting. Scans are repeated once a year so along with laboratory testing to see what the levels of hormones are. This is a good option for those who have a slow growing or stable tumor, for those who have few symptoms and for those who are not good candidates for brain surgery due to other health issues.
Some of the pituitary adenomas can be managed with medicine alone. Prolactinomas, for example, can be treated with caergoline or bromocriptine. Growth hormone-secreting tumors can be treated with medication that block the hormonal release. Even Cushing’s disease patients can be treated with ketoconazole if surgical methods are not possible.
Surgery may be the only option for some people. Surgery usually can be done by going in through the nose or through the sphenoid sinus. It is a surgery that takes in the range of 2-4 hours to complete and the person will need to be on replacement hormones for the rest of their life.
Radiosurgery works for some candidates. These include Gamma knife and Cyber knife surgery, although normal external beam surgery can be used as well. Radiation is finely focused on the pituitary gland with gradual improvement in symptoms. The need for replacement hormones is likely with this form of treatment as well.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here