Pituitary Adenoma

Pituitary tumours represent 10-15% of all intracranial tumours and are usually benign. They arise from the anterior pituitary and rarely grow infiltrative into surrounding tissue.

Histology of Pituitary Tumours

  • usually slowly growing tumours (WHO grade I)
  • also higher graded tumours can occur
  • arise from anterior pituitary
  • there are hormon-active (e.g. prolactinoma) and hormon-inactive pituitary tumours
  • according to their localisation and features they are graded from A to E

 

Epidemiology of Pituitary Tumours

      • usually in adult age, rarely in children
      • represent 10-15% of all intracranial tumours

           

          Symptoms of Pituitary Tumours

              • disturbed vision and restriction of visual field (in serious cases loss of sight)
              • hemiparesis
              • headache
              • rarely epileptic seizures
              • symptoms of hormon-active tumours depend on impact of the single hormons (e.g. Cushing´s disease)
              • hormon-inactive tumours can cause hormon-related deficiency symptoms (e.g. anaemia, fatigue, avolition)

                   

                  Diagnosing Pituitary Tumours

                      • with CT or MRI with contrast agent
                      • frequently hemorrhages
                      • usually clearly defined tumours
                      • endocrinological diagnostics in order to differentiate between hormon-active and hormon-inactive tumours


                          Therapy of Pituitary Tumours

                            hormon-inactive pituiatry tumours:

                            • surgical removal (usually transnasal)
                            • postoperative control of residual pituitary function
                            • if complete resection is not possible, usually additional radiotherapy
                            • no drug treatment necessary


                            hormon-active pituitary tumours:

                            • prolactinoma are treatet with dopamine agonists (as permanent therapy)
                            • hormon therapy frequently replaces surgery
                            • hormon-active tumours usually respond to drug treatment

                               

                              Therapy of Recurrent Pituitary Tumours

                                  • if possible (re-)operation
                                  • possibly (second) irradiation (single exposure or fractionated)

                                       

                                      Aftercare of Pituitary Tumours

                                          • requires coorporation between neuro surgeons and endocrinologists
                                          • for hormon-inactive tumours: CT or MRI once a year
                                          • for hormon-active tumours: regular measurements of hormons, if hormons increase MRI or CT

                                               

                                              Course of Pituitary Tumours

                                              hormon-inactive tumours:

                                              • become first conspicuous when they interfere with sourrounding environment
                                              • because of then possibly already existing infiltration of surrounding tissue they can not always be compleetly removed in surgery
                                              • tend to relapse

                                               

                                              hormon-active tumours:

                                              • 80-90% of patients respond to drug treatment
                                              • rarely recurrences after discontinue of drugs

                                               

                                              Prognosis of Pituitary Tumours

                                                  • with the established treatment hormon-inactive tumours can ususally be controlled in the long term
                                                  • with adequate therapy in good time hormon-active tumours have a good prognosis too

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