Pituitary Adenoma? Don't be afraid! Let's talk about this.

When we hear the word "tumor" in our head, everyone immediately gets scared, right? That's normal. But the most important thing we need to understand is that not all tumors that develop in the head are cancerous. Today we are going to talk about a tumor that develops in a small gland under our brain, but is most often not cancerous. This is called a pituitary adenoma in medical science. So let's talk about this in detail, very simply.

First, let's see, what is Pituitary Adenoma?

Simply put, a pituitary adenoma is a tumor that develops on your pituitary gland. But it is a benign tumor. That means it does not spread to other parts of the body like cancer. But as these tumors grow, they can press on the surrounding tissues and nerves. That's when various symptoms start to appear.

So, what is this pituitary gland?

The pituitary gland is a small, bone-shaped gland located just below the brain, behind the nose. It is connected to the hypothalamus in the brain. This small gland has two parts, the anterior lobe and the posterior lobe. Both of these parts produce several hormones that are essential for our body.

Hormones are like messengers in our bodies. They travel through the blood and instruct our organs, muscles, and other tissues to perform various functions.

Here are some of the main hormones produced by the pituitary gland:

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

Also, the pituitary gland signals other endocrine glands in our body to produce hormones. It's like a head office. So when a tumor forms in this gland, the function of one or more of these hormones can definitely change.

How are pituitary adenomas classified?

Doctors classify these tumors into two main types: based on whether they produce extra hormones or not, and based on their size.

Is this considered a brain tumor?

Yes. The pituitary gland is not technically part of the brain, but rather an endocrine gland attached to the brain. However, doctors consider a pituitary adenoma to be a brain tumor. This type of tumor accounts for only 10% of tumors that develop inside the skull.

What are the symptoms of a pituitary adenoma?

The symptoms of these tumors can vary greatly, depending on several factors:

• Whether the tumor is growing and damaging surrounding tissue or the pituitary gland itself (this is called mass effect).
• Is it a functioning tumor that secretes hormones, and if so, which hormone is secreted in excess?

Symptoms of pressure due to tumor enlargement (Mass Effect)

These symptoms are especially common in macroadenomas (large tumors).

• Vision problems: This is the main symptom. 40%-60% of patients experience vision loss (blurred vision, double vision). This is because as the tumor grows, it presses on the optic chiasm, where the optic nerves from our eyes meet. This causes loss of peripheral vision, especially in the eyes .
• Headaches: Headaches can occur as the tumor presses on surrounding tissue. However, since headaches are very common, they can also occur for other reasons.
• Hypopituitarism: A large tumor can damage the cells of the pituitary gland, reducing the production of one or more hormones. The symptoms of each hormone deficiency vary.
• LH and FSH hormone deficiency: This causes low estrogen levels in women and low testosterone levels in men. This is called hypogonadism . Symptoms include irregular menstrual cycles, decreased libido, fatigue, and sexual dysfunction in men.
• TSH hormone deficiency: This leads to decreased thyroid hormone production. This is called hypothyroidism . This can cause fatigue, constipation, dry skin, and a slow heart rate.
• ACTH hormone deficiency: This results in decreased production of the hormone cortisol. This is called adrenal insufficiency . Symptoms such as low blood pressure, nausea, vomiting, stomach pain, and loss of appetite may occur.
• GH hormone deficiency: Symptoms of growth hormone deficiency vary with age. Adults may experience fatigue and muscle weakness.

Symptoms caused by tumors that produce extra hormones (Functioning Adenomas)

These types of tumors produce too much of one or more hormones, which can lead to various health conditions.

Why do pituitary adenomas develop?

Scientists still don't know the exact cause, but it's believed that it's often caused by random changes (mutations) in our DNA . These changes cause cells in the pituitary gland to grow out of control and form a tumor.

Sometimes these can be linked to genetic conditions that are passed down through generations, but most of the time they occur randomly.

How to diagnose this condition?

Your doctor will order tests to diagnose this based on your symptoms. Sometimes, these tumors can be found accidentally during a head scan for another reason.

If your doctor suspects this condition, they may order the following tests:

• Blood tests: Depending on your symptoms, blood tests may be ordered to check various hormone levels.
• Imaging tests: An MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scan of the head can confirm the presence of this tumor.
• Eye exam: If you have vision problems, a visual field test will be performed to check the function of your eyes.

What are the treatments?

There are generally three treatment options for this: surgery, medication, and radiation therapy. Your medical team will decide which treatment is best for you based on the type, size, and symptoms of your tumor.

1. Surgery: If the tumor is causing hormonal imbalances or vision problems, the doctor may recommend surgery to remove all or part of the tumor.

• The most common (95%) method used for this is transsphenoidal surgery , in which a small camera and instruments are inserted through the nose to remove the tumor.
• If the tumor is very large, it may be necessary to resort to transcranial surgery, which is performed through the skull.

2. Medication: Some types of tumors, especially Prolactinomas , can be treated with medications. These medications shrink the tumor and control symptoms. Usually, medications such as cabergoline or bromocriptine are given for this. 80% of patients get good results with these medications.

3. Radiation therapy: This involves using high-energy X-rays to shrink the tumor or stop its growth. This is done using a special technique called stereotactic radiosurgery . This involves targeting the tumor with radiation beams while minimizing damage to surrounding healthy tissue.

What happens after treatment? Prognosis

The outlook for this is very good. After the tumor is completely removed with treatment, most people can live a full, healthy life.

Sometimes, surgery or radiation therapy can damage the pituitary gland, causing low hormone levels (hypopituitarism). In this case, you may need to take hormone replacement pills for the rest of your life to replace the low levels of hormones.

These tumors can sometimes recur, so it is very important to attend regular medical checkups even after treatment.

What complications can occur if left untreated?

If left untreated, especially large tumors (macropadenomas) and hormone-producing tumors (functioning adenomas) can cause serious health problems.

What happens here is that the tumor suddenly bleeds into or out of the tumor. The tumor suddenly grows and damages the pituitary gland. The symptoms of this appear suddenly.

• A very severe, sudden headache.
• Double vision or inability to open the eyelids due to dysfunction of the eye muscles.
• Sudden loss of vision or loss of side vision.
• Sudden drop in blood pressure, nausea and vomiting.

If you experience one or more of these symptoms, you should go to the nearest hospital Emergency Department (ETU) without delay. This is a life-threatening emergency.

It's normal to feel scared when you're diagnosed with a pituitary adenoma. But remember, these are often not cancerous. And, with today's advanced treatments, they can be completely cured. Talk openly with your doctor and ask all your questions.

Pituitary Adenoma, Brain Tumors, Hormonal Problems, Pituitary Gland, Headaches, Vision Problems