Description pituitary adenoma
The pituitary gland or pituitary gland is part of the brain that is the seat of production of several hormones. Pituitary tumors are overwhelmingly benign (benign). In addition, already being treated relatively easily, so definitely not to diseases which require more feared.
These benign tumors are called adenomas. Adenoma disorder arises random DNA pituitary endocrine cells that produce different hormones. Always depends on the type of cells that are affected by this genetic defect, because each type of endocrine cell produces only one particular hormone.
Excessive production of hormones
Somatropin is a growth hormone that affects a number of functions in our body, not only bone growth (for children), but also the muscles, joints and organs (for children as well as adults). He himself is driven from the higher nervous center (hypothalamus) producing hormone somatoliberin.
When the above-mentioned genetic error at the level of production and action somatoliberinu or somatotropin, is developing the so-called. Acromegaly or gigantism – the excessive growth of excess production of these hormones the tumor – adenoma.
Another pituitary hormone prolactin. Under normal circumstances it has a particular influence on the production of milk in pregnant women. If it is produced to an increased extent in turn can cause problems with sterility and menstrual cycle in women with disorders of potency and sex drive in men.
ACTH (adrenocorticotropic hormone) pituitary produces therefore to stimulate adrenocortical function, which also produce a variety of hormones. This ancient system is important for stressful situations (excessive stress both mental and physical), which is due to ACTH releases cortisol from the adrenal cortex.
If this happens in a large amount, the patient has called. Cushing’s disease. Conversely, a small or insufficient production of ACTH and consequently cortisol is associated with secondary adrenokrotikální insufficiency (ie adrenal insufficiency). This can be especially dangerous without treatment, when the patient gets into stressful situations. Therefore, it is always necessary replacement therapy, if the patient has a lack of ACTH and cortisol.
There are other types of pituitary adenomas – from cells producing TSH (thyroidea, or thyroid stimulating hormone) and cells forming FSH and LH (follicle stimulating hormone and luteinizing hormone – both have influence on the correct functioning of the gonads – the ovary in females and the testis in men). However, they are too frequent or significant, since only rarely causes problems for patients.
We can summarize that a patient with a pituitary adenoma will either have acromegaly, gigantism, disorders of excessive production of prolactin, or Cushing’s disease.
It always depends on cells producing a particular hormone. Sometimes the secretion of more hormones, and may e.g. acromegaly combined with production of prolactin (the most frequent combination), but mostly prevailing one hormone secretion, which then determines the patient’s symptoms and problems.
Often it happens that the patient does not experience any significant difficulty, in which case it isafunční adenoma, ie. adenoma which produces defective hormones, or such, which are then equally apply and do not therefore difficulties.
Often even come to a pituitary tumor by accident when brain imaging with CT or MRI scan for another disease, then such an adenoma say incidentaloma. Already Hence, if the tumor does not increase over the years and the patient do not mind (or even know about it) can live with this for the rest of life, and nothing happens.
Insufficient hormone production
Although the tumor produces an excess of one or more hormones (in case hyperfunkčního adenoma), but on the contrary also occurs attenuation secretion of other hormones, which is another possible source of the patient’s symptoms. Adenoma namely oppressing residue healthy pituitary and in this way can penetrate as the above mentioned adrenocortical insufficiency.
In addition to adrenal suppression through the pituitary gland sometimes affected thyroid function, genitals or frequently experience the symptoms of the failure of growth hormone. Professionally, this lack of one of hormones called hypopituitarism. If so great oppression or bleeding that affected the entire pituitary gland are talking about panhypopituitarismu (pan is full).
Prevention and Risk Factors pituitary adenoma
They are the same as for all other tumors. Tumor always develops on the basis of a defect in the genetic information (DNA) in one cell, from which either are more cancer cells.
The defect can occur due to many factors such as chemicals, radiation (X-rays, gamma rays, …) and carcinogenic substances in cigarettes, some foods and medicines.
Of course there is no tumor formation after a single X-ray irradiation or ignition of one cigarette, but all of these factors have a cumulative effect, so if smoke long term, increased risk of these defects (mutations) in the DNA, which will give rise to a tumor cell.
In addition to these external influences that can affect to some extent, that heredity plays a role as well, which of course we can not affect. If there were some in your family cancer (and not necessarily just the pituitary gland), is a slightly higher risk of other cancers compared with healthy families.
Specific prevention against tumors of the pituitary gland does not exist, and in practice it is not realistic to avoid all influences which can cause tumors. However, if we exclude smoking, we do so preventative measures both generally against tumors and also against heart disease, which are among the leading cause of death in our population (myocardial infarction, heart failure, …).
Acromegaly and gigantism
Acromegaly is caused by increased production of growth hormone (STH – somatotropin) in adulthood, while gigantism develops if the tumor with the production of STH formed in the period before the completion of growth.
In both cases, it is not a very common disease and during the period of growth is difficult at first glance to distinguish overgrowth, which is more physiological, from gigantism. For this purposediagnostic tests (mainly laboratory values MET levels).
We shall now deal with acromegaly, since the symptoms are similar to the difference in the accelerated growth and treat gigantism with equally.
symptoms of acromegaly
Leading symptom is enlargement of certain body parts, especially of the hands or feet in width (not in length!). Also enlargement of the nose, jaw and deepening of the “wrinkles” or grooves that go along the sides of the nose to the lips, is striking.
The problem is that although human acromegalic stranger (e.g. a doctor who sees the patient first) detects the naked eye coming out this disease late.
The reason is the gradual development of changes, which you notice the surroundings when in contact with patients every day (sometimes not even reveal practitioner acromegaly).
The patient may also have an enlarged tongue, teeth to spread out (it happens that notices it sends dentist and the patient’s endocrinologist) and increased formation of caries. Often patients are sweating and joint pain, which is associated with advanced osteoarthritis based on enlarging cartilage. Suffer from headaches, which can be through medication only badly affect (this may be the case with other pituitary tumors).
When the tumor is also associated with the production of prolactin, the women are disorders of the menstrual cycle. 20% spuriously has both diabetes or on its boundary. More frequent is the occurrence of a higher blood pressure.
At the beginning of disease patients have greater muscle strength (growth hormone is misused for doping in athletes) in advanced stages power is decreasing and patients describe weakness.
treatment of acromegaly
It is primarily a matter of operational to remove the adenoma. Operates mostly through the nasal passages, so do not worry that it was a complex exercise that requires opening the skull.Conversely surgery carries minimal surgical risk, because thanks to this modern approach no danger of infection. For the patient, it is also convenient as it can go home the next day. The only thing that can cause inconvenience, it is cold, which emerges from the irritation of the nasal mucosa. This, however, will disappear in a few days.
If the adenoma not eliminate, the performance is repeated or if your doctor sends a Leksell Gamma Knife irradiation. It is painless and minimizes the burden arising from radiation because it’s targeted radiation only certain tissues (ie our adenoma) with sparing healthy tissue (neozáří whole brain).
Other treatment options include drugs, some are relatively expensive. These are octreotide and similar drugs (Sandostatin SOMATULINE), which are injected once a month, which is quite convenient, and also of pegvisomant (SOMAVERT), which is considered most effective.
complications of acromegaly
If no tumor is removed, continued increased secretion of MET and that has the effect of alsoincreasing the internal organs. The heaviest impact it has on the heart, which then not sufficient to pump the blood and leads to heart failure (contributes to higher blood pressure and diabetes).This shortens the life of patients by about ten years.
Another problem is the oppression of other structures of the brain tumor. The consequence of the above mentioned adrenal insufficiency (adrenocortical insufficiency), and the necessity of replacement of natural glucocorticoids (cortisol), by themselves or synthetic tablets. It ishydrocortisone or prednisone used usually in the morning.
When increasing body burden (sport, manual labor, …) or stress, it is necessary dose myself up a bit more. From your doctor, you also receive a card that you carry in your wallet, and where it will be written that are taking corticosteroids, so that if eg. Any injury or operation knew I had to get these drugs. This is true of all tumors of the pituitary gland, where it will be suppressed adrenal function.
Equally all tumors and that, if the tumor is too large, it can push the optic nerves, which are close to the pituitary, which would be reflected impaired vision, especially failure of the visual field(measured perimeter). Sick person then has limited peripheral vision, as if looking into a pipe.Sometimes it happens that the tumor appears to an eye doctor had just suffered impaired vision.
Whether you have a tumor detected anywhere doctor will in any case be sent to the perimeter, to see how the tumor is large. Once the oppressed optic nerves, it might not be suitable for surgery or radiation.
Larger tumor surgery has its limit on the operating approach through the nasal passages.
prolactinoma
Prolactinoma is a pituitary tumor with increased prolactin. They make up one third of all pituitary adenomas, so it is relatively common. Do not make too much trouble and even the treatment is unpleasant.
symptoms of prolactinoma
Prolactin in increased quantities counteracts the function of the gonads. In women, i.e. menstrual cycle disorders and sterility, and sometimes, they may occur as the milk from the mammary gland.
For men, decrease sexual appetite, potency and sperm production, but usually not completely stopped (so there is much sterility in women). Breast enlargement in men occurs rarely. If prolactinoma develop in boys during puberty occurs arrest pubertal development.
If the doctor accidentally caught in the blood (like when another examination) higher prolactin levels, it does not necessarily greatly mean that the patient has a prolactinoma, because higher levels of lead and other factors (stress, overheating eg. Sauna, breastfeeding, pregnancy, certain drugs etc.), a critical examination of magnetic resonance imaging.
treatment of prolactinoma
Unlike acromegaly with prolactinomas most commonly treated by administration of drugs that block production of prolactin. They are terguride (Mysalfon), bromocriptine (Parlodel, Serocryptin, Medocriptine), cabergoline (Dostinex), or quinagolide (Norprolac). The tablets are taken at night.Most patients will lead to normal plasma prolactin and therefore the normal function of the gonads with the possibility of pregnancy.
Cushing’s disease
It is caused by overproduction of ACTH pituitary tumor. This makes it raised cortisol associated with him all the symptoms. It is mostly small adenomas, so treatment is again promising.
Do not confuse the concept of Cushing’s disease and Cushing’s syndrome, which is a superset of Cushing’s disease, but also includes other diseases that are different especially in the treatment and prognosis (they are much more serious), together have just overproduction of cortisol and symptoms.
Symptoms of Cushing’s Disease
The main symptom is a change in the distribution of body fat – increases the abdomen, rounded face and back creates a hump. Legs and arms remain unchanged, but the contrast with the rest of the body.
Other symptoms may be expressed at all. Sick may be tired and without sentiment. Excess cortisol also causes osteoporosis, skin, female disorders of the menstrual cycle.
Treatment of Cushing’s Disease
Treatment is similar to that for acromegaly – a number one choice is surgical removal of thepituitary tumor, which is usually not complicated.
In second place it is again gamma knife irradiation followed by treatment with pharmacological – must suppress cortisol before irradiation begins to occupy (namely it has an effect until after a year or two).
Other names: pituitary tumor, pituitary cancer, hypopituitarism, panhypopituitarismus, incidentaloma, inoperative adenoma, hyperfunctioning adenoma, prolactinoma, acromegaly, gigantism, Cushing’s disease
