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
