Pituitary Adenoma
Brooke Hildt and Jim Hutchins
Overview
Pituitary Adenomas are benign tumors of the pituitary gland, most commonly located in its anterior lobe. These tumors may secrete one or more hormones in excess (secretory pituitary adenomas) or be clinically inactive/asymptomatic (non-secretory). Hormonal hypersecretion can disrupt the regulation of several key physiological functions, including growth, metabolism, reproduction, stress response, lactation, fluid and electrolyte balance, and the processes of labor and childbirth. They can be further classified by size into microadenomas (less than 10 mm in diameter) and macroadenomas (greater than 10 mm).
Signs & Symptoms
- Headache
- Vision changes
- Weight gain
- Lactation
- Erectile dysfunction
- Menstrual irregularities
- Behavioral changes
Diagnosis
The diagnosis of a Pituitary Adenoma typically includes both blood and urine testing to detect hormone level abnormalities, magnetic resonance imaging (MRI) to visualize the tumor, and spectral domain optical coherence tomography (SD-OCT) to identify retinal nerve fiber layer and ganglion cell loss in the retina. Specific blood tests used in the diagnosis may include but are not limited to: levels of plasma prolactin (PRL), growth hormone (GH), insulin-like growth factor-1 (IGF-1), free thyroxine, cortisol, and testosterone.
Treatment
The treatment of Pituitary Adenomas typically involves surgical resection, radiation therapy, and/or the use of pharmacologic agents depending on the size and behavior of the tumor.
Risk Factors & Disease Prevalence
- 1 in 10 people will develop a pituitary adenoma in their lifetime
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People can develop a pituitary adenoma at any age
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50% of pituitary tumors are endocrine-active
- Account for 12% of all intracranial tumors
Case Study
A 48-year-old female presents with progressive bilateral vision loss. Patient history reveals no fatigue, mood change, or weight gain. Her past ocular, medical, and family history was non-contributory. Best-corrected visual acuity was hand motion in the right eye and 2/3 in the left eye. MRI revealed a pituitary macroadenoma with suprasellar extension. Resection was performed and the pathological diagnosis was nonfunctioning adenoma. Despite the surgery, the patient’s vision did not improve.
https://my.clevelandclinic.org/health/body/21459-pituitary-gland
https://www.hopkinsmedicine.org/health/conditions-and-diseases/pituitary-adenoma#:~:text=Pituitary%20adenomas%20are%20benign%20tumors,or%20more%20hormones%20in%20excess