Do you have a tumor on your pituitary gland? (Pituitary Adenoma) Let's learn about it!

Do you also sometimes get headaches for no reason? Or do you feel like your eyesight is a little weak, and you can't see things coming from the sides properly? Or, do you have any discomfort caused by some changes in your body's hormones? Perhaps the reason behind these things is a small tumor that develops in your pituitary gland. Today, we will talk in detail about this condition called `Pituitary Adenoma` . Don't worry, this is not cancer.

What is a pituitary adenoma?

Simply put, a pituitary adenoma is a non-cancerous (benign) tumor that develops in your pituitary gland. It does not spread to other parts of the body like cancer. That is the most important thing. However, as this adenoma grows, it can press on things like nerves and blood vessels around it. That is when symptoms start to appear.

So, what is this pituitary gland?

Imagine, behind our nose, connected to the base of the brain, the ``Hypothalamus``, there is a small gland about the size of a pea. That's what it's called the pituitary gland. Although it's small, it performs a very important function in our body. This gland has two main parts:

• Anterior Lobe
• Posterior Lobe

Both of these parts produce and release various types of hormones into the bloodstream. Hormones are like chemical messengers that control and coordinate various activities in our body. They travel through the bloodstream and deliver necessary messages to our organs, muscles, and other tissues. Here are some of the important hormones produced by the pituitary gland:

• Adrenocorticotropic hormone (ACTH or Corticotropin)
• Antidiuretic hormone (ADH or Vasopressin)
• Follicle stimulating hormone (` FSH` )
• Growth hormone (`GH`)
• Luteinizing hormone (`LH`)
• Oxytocin (` Oxytocin` )
• Prolactin
• Thyroid stimulating hormone (`TSH`)

Not only this, the pituitary gland also "signals" other endocrine glands in our body to produce hormones. So you can understand that if there is a problem with this pituitary gland, such as an adenoma, the function of one hormone or several hormones can be affected.

How are these types of adenomas distinguished?

Doctors classify pituitary adenomas into two main types: 1. Based on whether they produce hormones or not:

• Functioning/Secreting adenoma:In addition, these types of adenomas produce one or more pituitary hormones . Therefore, different symptoms and conditions can occur depending on the hormone that is overproduced.
• Nonfunctioning/Non-secreting adenomas: These adenomas do not produce hormones. However, if they grow large, they can cause symptoms by pressing on nearby brain areas or nerves . This is the type of adenoma that doctors encounter most often.

2. By size:

• Microadenomas: These are tumors smaller than 10 millimeters (that is, 1 centimeter).
• Macroadenomas: These are tumors larger than 10 millimeters. Macroadenomas are about twice as common as microadenomas. They are also more likely to cause low levels of one or more pituitary hormones (a condition called hypopituitarism).

Is this considered a brain tumor?

The pituitary gland is actually a structure that belongs to the endocrine system, and is not technically part of the brain. It is attached to the base of the brain. However, doctors consider pituitary adenomas to be a type of brain tumor . Pituitary adenomas account for only 10% of primary brain tumors.

Who gets these more often? How common is it?

Pituitary adenomas can develop at any age. However, they are most common in people in their 30s and 40s . Women are also slightly more likely to develop them than men. They are so common that they account for 10% to 15% of all tumors that grow inside the skull. According to statistics, about 77 out of 100,000 people have the condition. However, researchers believe that many more people, perhaps as many as 20%, will develop one at some point in their lives. Many times, especially those with microadenomas (`microadenomas`), do not have any symptoms, so they go undetected.

What are the symptoms of a pituitary adenoma?

The symptoms of a pituitary adenoma can vary greatly from person to person. It mainly depends on several factors:

• Whether the adenoma grows in size and damages the pituitary gland itself, or whether it causes a ``mass effect'' on surrounding structures.
• Is it a hormone-secreting (`functioning`) adenoma? If so, the symptoms will depend on the type of hormone it produces.

`Mass Effect` symptoms caused by `Macroadenomas` (large tumors)

Large adenomas (`Macroadenomas`) cause symptoms mainly due to the pressure on surrounding tissue.

Just think, if you put a large item in a small room, it's like there's not enough space for other things and it's crowded.

• Eyesight problems:

About 40% to 60% of people with a large pituitary adenomaVision loss (blurred vision, double vision) occurs. This occurs because the adenoma presses on the optic chiasm, which connects the eyes and the brain. This can cause a loss of peripheral vision, especially in the side. It is like a horse losing its vision on both sides.

• Headaches :

Many people with pituitary adenomas complain of frequent headaches. This may be due to the tumor pressing on surrounding tissue. However, since headaches are usually caused by many things, they can also be caused by other things.

• Hormonal Deficiency:

Large adenomas (`Macroadenomas`) can damage the pituitary gland tissue and reduce the production of one or more pituitary hormones. This condition is called `Hypopituitarism`. The symptoms that occur when each hormone is reduced also vary.

• When LH and FSH hormones decrease (`Hypogonadism`): The levels of ` Oestrogen` in women and ` Testosterone` in men decrease. This can cause symptoms such as excessive sweating , vaginal dryness in women, ` Erectile Dysfunction` in men, decreased facial and body hair growth, mood swings in both men, decreased sexual desire, and extreme fatigue.
• When TSH hormone levels decrease (`Hypothyroidism`): The amount of hormones produced by the thyroid gland decreases. This can cause symptoms such as fatigue, constipation, slow heart rate, dry skin, swelling of the limbs, and impaired reflexes.
• When ACTH hormone is low (`Adrenal Insufficiency`): The body's production of the hormone `Cortisol` decreases. This can cause symptoms such as low blood pressure, nausea, vomiting, abdominal pain, and loss of appetite.
• GH (Growth Hormone Deficiency): Symptoms vary depending on age. Adults may experience fatigue and loss of muscle mass.

Symptoms of functioning adenomas

In addition to secreting one or more hormones, a functional adenoma can cause various symptoms and conditions related to each hormone.

• Prolactinomas (also known as Lactotroph Adenomas):

These adenomas produce too much of the hormone prolactin . This condition is called hyperprolactinemia. Only about 4 out of 10 pituitary tumors are of this type. This is the most common type of pituitary adenoma.When prolactin levels increase, the normal functioning of the reproductive system in both women and men can be disrupted.

• Infertility is a condition in which both men and women have difficulty conceiving children.
• A milky discharge from the breasts even when not pregnant (`Galactorrhea`).

• Somatotroph Adenomas:

These adenomas produce excessive amounts of growth hormone (`Growth Hormone` or `Somatotropin`) . About 2 out of 10 pituitary tumors are of this type. The symptoms caused by this vary with age.

• Adults: A rare but serious condition called `Acromegaly` occurs. In this, the bones and tissues of the body grow abnormally. Over time, the hands, feet, and head become larger, and the shape of the face changes. It also affects blood sugar control, and the heart muscle can also enlarge.
• Children and young adults: A condition called gigantism occurs. They grow abnormally tall due to excess growth hormone.

• Corticotroph Adenomas:

These adenomas produce too much ACTH (adrenocorticotropic hormone) . About 1 in 10 pituitary tumors are of this type. The ACTH hormone stimulates the adrenal glands to produce more steroid hormones such as cortisol. This causes Cushing's Syndrome (excess cortisol).

• High blood pressure.
• Muscle weakness.
• Easy bruising.
• Wide (more than 1 cm) purple stripes (`Stretch Marks`) appear on the abdomen.
• Osteoporosis.
• Compression fractures.
• Type 2 Diabetes Mellitus.

• Thyrotroph Adenomas:

These adenomas produce excessive amounts of TSH (thyroid stimulating hormone) . These are very rare. TSH stimulates the thyroid gland to produce more thyroid hormones. This causes `Hyperthyroidism` (overactive thyroid condition), which speeds up the body's metabolism.

• Increased heart rate.
• Weight loss without any reason.
• Frequent loose stools.
• Sweating.
• Hand tremors.
• Anxiety.

Important: There are many other causes of hyperthyroidism. A pituitary adenoma is a very rare cause.

• Gonadotroph Adenomas:

These adenomas produce excessive amounts of gonadotropins (i.e., the hormones LH and FSH). This is also very rare.

• This can cause women to experience irregular menstrual cycles and conditions such as Ovarian Hyperstimulation Syndrome (OHSS).
• Men may experience symptoms such as enlarged testicles, deepening of the voice, hair loss (behind the ears), and rapid growth of facial hair.
• Children can also experience precocious puberty.

What are the causes of pituitary adenoma?

Scientists still don't know exactly what causes these adenomas. However, some adenomas are thought to be linked to random changes (`mutations`) in the genes (`DNA`) in our cells. These genetic changes cause the cells in the pituitary gland to grow rapidly and form a mass. These genetic changes can sometimes be inherited from parents to children (hereditary), or they can develop completely randomly. In addition, pituitary adenomas can also be linked to some rare genetic conditions . Some examples are:

• ``Multiple Endocrine Neoplasia type 1 (MEN1)''
• ``Multiple Endocrine Neoplasia type 4 (MEN4)''
• `Carney complex`
• `X-LAG syndrome`
• ``Succinate dehydrogenase-related familial pituitary adenoma''
• `Neurofibromatosis type 1`
• ``Von Hippel–Lindau syndrome''

A person with this genetic condition is at increased risk of developing a pituitary adenoma. However, it is important to remember that people without any such genetic condition can also develop these adenomas.

How do doctors diagnose this condition?

The process of diagnosing a pituitary adenoma varies depending on the type of adenoma you have and whether it is causing symptoms. In most cases, a person with a hormone-secreting adenoma (`Functioning Adenoma`) is first diagnosed with a hormonal imbalance (e.g. `Cushing's Syndrome`, `Acromegaly`) based on the symptoms. Only then is the adenoma discovered when the cause is investigated. This is because many conditions caused by excess hormones can have other causes besides pituitary adenomas. The same can be said about pituitary hormone deficiency (`Hypopituitarism`). Sometimes, a pituitary adenoma is discovered as an `Incidental Finding` during a head scan (`Imaging Test`) for another condition. Most adenomas that are found like this are usually small in size and non-functioning.

What tests are done for this?

If your doctor suspects you may have a pituitary adenoma, he or she will take a careful look at your symptoms, medical history, and perform a physical exam. In addition, they may recommend one or more of the following tests:

• Blood Tests: Depending on your symptoms, blood tests may be ordered to check the levels of various pituitary hormones.
• Imaging Tests: An MRI (Magnetic Resonance Imaging) scan of the head orA `CT (Computed Tomography)` scan can produce clear images of the structures inside the head. These tests can confirm whether a pituitary adenoma is present and how large it is. An `MRI` scan is the most appropriate and sensitive test for this.
• Eye Exam: If you have any vision problems, your doctor may order a visual field test. This test is important because large pituitary adenomas can cause vision problems by compressing the optic nerve, which connects the eyes to the brain.

How is a pituitary adenoma treated?

There are three main ways to treat pituitary adenomas: surgery, medication, and radiation therapy. Sometimes one or more of these methods may be used together. Because everyone's adenoma and condition are different, you and your medical team can work together to determine the treatment plan that's best for you.

Surgery to remove adenoma

If you have an adenoma that is causing hormonal imbalances or affecting your vision, your doctor will likely recommend surgery to remove all or part of the adenoma. Depending on the size of the adenoma and the severity of your symptoms, more than one surgery may be necessary. Surgeons often perform this procedure using a surgical technique called `Transsphenoidal Surgery` . This involves going through the nose and through the sphenoid sinus (a hollow space behind the nasal cavity, below the brain) to reach the pituitary gland and remove the adenoma. About 95% of pituitary tumors are removed this way. It is a relatively safe procedure. However, if the adenoma is too large to be removed through the nose or is in a difficult location, the surgeon may have to perform a transcranial surgery. This is a rare procedure for pituitary adenomas.

Treatment with medication

Some types of pituitary adenomas, especially prolactinomas , can be controlled and shrunk with medication. People with prolactinomas (these are the most common type) are initially treated with a dopamine agonist, such as Cabergoline (Dostinex®) or Bromocriptine (Cycloset®), for several months.

The good news is that in about 80% of cases, these drugs shrink the prolactinoma and return prolactin hormone levels to normal.

If medications don't work or if it's a different type of adenoma, your doctor may recommend surgery.

Radiation Therapy

Radiation therapy uses high-energy X-rays to destroy adenoma cells, shrinking the tumor or stopping it from growing. Stereotactic Radiosurgery for Pituitary Adenomas(e.g. `Gamma Knife`®) A special, highly precise radiation therapy method is used. In this, several beams of radiation are aimed at the adenoma from different directions, minimizing damage to surrounding healthy tissue. This method is used for residual areas after surgery or in cases where surgery is not possible.

What are the side effects of the treatment?

As with any medical treatment, treatment for pituitary adenoma can have some side effects.

• After surgery and/or radiation therapy, about 60% of people with pituitary adenomas may develop `Hypopituitarism` (decreased production of one or more pituitary hormones). Although this is a lifelong condition, hormone replacement medications can help people live a normal life.
• Possible complications from surgery:
• Bleeding.
• Cerebrospinal Fluid (CSF) leak (watery fluid coming out of the nose).
• Meningitis (an infection of the membranes covering the brain).
• Diabetes Insipidus (excessive urination and excessive thirst due to a lack of antidiuretic hormone).
• Common side effects of dopamine agonist drugs for prolactinoma include: headache, nausea, vomiting, dizziness, and sometimes compulsive behavior.
• Possible side effects of radiation therapy:
• Pituitary hormone deficiency (may occur over time).
• Impaired Fertility.
• Loss of vision and damage to brain tissue (very rare).
• Another tumor may develop at the same site years after treatment (very rare).

Can the formation of these adenomas be prevented?

Unfortunately, there is nothing you can do to prevent pituitary adenomas. Most of the time, they occur randomly. However, they may be associated with some of the rare genetic conditions mentioned earlier. If a close family member (brother, sister, or parent) has a genetic condition like this, you can talk to your doctor about genetic counseling and testing to see if you also have the condition. If you do, your doctor can monitor you closely and detect any adenomas early so that they can be treated.

What is the prognosis of this condition?

The outlook for a pituitary adenoma, that is, your recovery and future health, depends on the size and type of adenoma, and the treatment you receive .

The good news is that in most cases, when the adenoma is completely removed or controlled with treatment, patients can live full, healthy lives again.

In some cases, treatment can reduce the production of hormones by the pituitary gland. If this happens, you may need to take hormone replacement drugs for the rest of your life to replace the reduced hormones. Adenomas can sometimes recur. This means that they may need to be treated again after a while. Statistics show that about 18% of people with inactive adenomas and about 25% of people with prolactinoma may need treatment again in the future. Therefore, it is very important to maintain regular contact with your doctor and have regular check-ups.

Is it possible to live with a pituitary adenoma?

Yes, you can. If the pituitary adenoma is small and does not cause any symptoms, you can live with it normally. In fact, many people only find out they have an adenoma when they have a head scan for another reason. However, if the adenoma continues to grow or starts to cause symptoms, you will definitely need treatment. If you have a large and/or active (hormone-producing) pituitary adenoma, you will definitely need treatment. This is because some pituitary adenomas can have a significant impact on your health and quality of life.

What complications can occur if left untreated?

If left untreated, some pituitary adenomas – especially large adenomas (`Macroadenomas`) and functional (`Secreting`) adenomas – can cause serious health problems . These health problems depend largely on the type of hormone secreted by the adenoma (we discussed this earlier in the `Symptoms` section). A very rare but extremely dangerous complication of untreated pituitary adenomas is `Pituitary Apoplexy`. This is a `Medical Emergency`. This occurs when there is bleeding into or out of the pituitary gland. `Pituitary Apoplexy` is most often caused by bleeding into a pituitary adenoma. The tumor suddenly enlarges, damaging the pituitary gland. The larger the adenoma, the greater the risk of developing `Pituitary Apoplexy`. The symptoms of `Pituitary Apoplexy` usually appear very quickly and can be life-threatening . The main symptoms are:

• A very severe headache (like the worst headache I've ever had in my life).
• Double vision or inability to lift an eyelid due to dysfunction of the eye muscles.
• Loss of side vision or complete loss of vision in one or both eyes.
• Acute adrenal insufficiency causes low blood pressure, nausea, and vomiting.
• Personality changes (e.g., confusion) due to sudden narrowing of the anterior cerebral artery in the brain.

Pituitary apoplexy is a rare condition, but it is very serious. If you experience one or more of these symptoms, call emergency medical services (such as 911) immediately or have someone take you to the nearest hospital emergency room.

When should you see a doctor?

• If you have any vision problems (blurred vision, double vision, decreased peripheral vision) and/or persistent or recurring headaches (especially in the forehead area), see a doctor and tell them about it.
• If you have already been diagnosed with a pituitary adenoma, you will need to see your doctor regularly to monitor the condition of the adenoma and to make sure that the treatment is working properly.

Finally, remember these things:

It is very normal to feel scared and worried when you find out that you have a tumor. However, the good news about pituitary adenomas is that they are mostly (over 99%) non-cancerous (benign) and in most cases, treatment can lead to very good results. Remember, your doctor is your partner in achieving your best health. Therefore, never hesitate to inform your doctor about any symptoms, discomfort, or questions you may have about your treatment. With the right information and timely treatment, you can definitely manage this condition successfully.