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General Practice 2023

Pituitary adenomaário: what é, main causes and treatment

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Pituitary adenomaário: what é, main causes and treatment
Pituitary adenomaário: what é, main causes and treatment
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Pituitary adenoma, also known as pituitary adenoma, is a benign tumor of the pituitary gland, which is a gland located in the brain and is responsible for controlling the production of hormones such as cortisol, prolactin, growth hormone and hormones that stimulate the functioning of the ovaries and testes, for example.

This type of tumor is rare and, as it is benign, it is not life-threatening, however it can cause symptoms that decrease quality of life such as infertility, decreased libido, milk production or neurological symptoms such as pain headache or partial loss of vision.

Whenever symptoms appear that may indicate a pituitary adenoma, it is important to consult an endocrinologist, neurologist or oncologist to carry out diagnostic tests, identify the problem and initiate the most appropriate treatment.

Main symptoms

In most cases, the common symptoms of pituitary adenoma are headache, decreased vision, decreased sexual appetite and menstrual cycle changes in women.

However, there are other symptoms that may appear and they vary according to the type of hormone that has been affected by the adenoma:

1. Lactotrophic adenoma

Lactotrophic pituitary adenoma is characterized by hyperprolactinemia, which is an increase in the hormone prolactin, responsible for milk production. In this type of adenoma, the main symptom is the production of milk in the breasts of men or women who are not breastfeeding.

Furthermore, other symptoms that may occur are decreased sexual appetite, infertility, menstrual changes or impotence in men.

2. Somatotrophic adenoma

Somatotrophic pituitary adenoma is characterized by increased production of growth hormone and can cause an increase in the size and thickness of the fingers and toes, in addition to an enlargement of the forehead, jaw and nose that change the face shape. This condition is known as acromegaly in adults or gigantism in children.

Furthermore, other symptoms that may occur include joint pain, muscle weakness, decreased sex drive, changes in menstrual cycle, increased sweat production, or tiredness.

3. Corticotrophic adenoma

Corticotrophic pituitary adenoma is related to increased production of the hormone cortisol which is responsible for increasing blood glucose levels and fat deposition in tissues and organs.

Usually, this type of pituitary adenoma can cause Cushing's syndrome which causes symptoms of rapid weight gain, accumulation of fat on the face and back, muscle weakness, the appearance of hair in the ears and skin problems such as acne and difficulty healing, for example.

Furthermore, this type of pituitary adenoma can cause depression and mood swings.

4. Gonadotropic adenoma

Gonadotropic pituitary adenoma is related to increased production of hormones that control ovulation in women and sperm production in men. However, this type of pituitary adenoma has no specific symptoms.

5. Thyrotrophic adenoma

Thyrotrophic adenoma is a type of pituitary adenoma in which there is an increase in the production of thyroid hormones, which can cause hyperthyroidism. Symptoms of this type of pituitary adenoma include increased heart rate, nervousness, agitation, weight loss, tremor or projection of the eyeball, for example.

6. Non-secretory adenoma

Non-secretory pituitary adenoma is a type of pituitary adenoma that does not interfere with hormone production, does not cause an increase in hormones, and usually has no symptoms.However, if the adenoma continues to grow, it can put pressure on the pituitary gland and result in hormonal changes.

Causes of pituitary adenoma

The causes of pituitary adenoma are still unknown, however some studies show that this type of tumor can occur due to changes in the DNA of cells or in people who have other risk factors such as:

  • Multiple endocrine neoplasia: this syndrome is a rare hereditary disease caused by changes in the DNA that cause a tumor or increase in the growth of several glands in the body, including the pituitary gland, which can increase the risk of pituitary adenoma;
  • McCune-Albright Syndrome: this rare genetic syndrome occurs due to changes in DNA and can cause changes in the production of pituitary hormones and, in addition to bone and skin problems;
  • Carney Complex: is a rare familial genetic malignant syndrome that can cause pituitary adenoma and other associated cancers such as prostate or thyroid and ovarian cysts.

Furthermore, exposure to radiation may increase the risk of DNA alterations and the development of pituitary adenoma.

How to confirm the diagnosis

The diagnosis of pituitary adenoma is made by the neurologist or oncologist according to the symptoms and laboratory tests to analyze hormone levels and includes:

  • Cortisol in urine, saliva or blood;
  • Luteotrophic hormone and follicle stimulating hormone in the blood;
  • Blood prolactin;
  • Glycemic curve;
  • Thyroid hormones like TSH, T3 and T4 in the blood.

In addition, to confirm the diagnosis, the physician may order a pituitary MRI.

How the treatment is done

Treatment of pituitary adenoma can be done with the use of drugs or surgery and depends on the type of adenoma and the size of the tumor:

Surgery

Surgery is indicated when the pituitary adenoma is non-secretory and larger than 1 centimeter. Furthermore, in this case, surgical treatment is only indicated if there is a symptom of loss or change in vision.

When the non-secretory tumor is smaller than 1 centimeter or without symptoms, treatment is done with regular medical follow-up and magnetic resonance imaging to assess tumor growth over time. if necessary, the doctor may recommend the use of medication or surgery.

Furthermore, for pituitary adenomas in which there is an alteration in the growth hormone or cortisol, surgery may also be indicated, as well as the use of medication.

Medicines

Drugs used to treat adenoma vary with the type of adenoma and include:

  • Pegvisomant, octreotide or lanreotide: indicated for somatotrophic adenoma;
  • Ketoconazole or mitotane: indicated for corticotrophic adenoma;
  • Cabergoline or bromocriptine: indicated for lactotrophic adenoma.

In addition, the doctor may recommend radiotherapy in cases of somatotrophic or corticotrophic adenoma.

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