Pituitary adenoma - a hidden and dangerous
Where it comes from is hard to say. Therefore, to prevent its development, to identify the cause of the reliable and predict the course of disease, modern medicine can not. The pituitary gland is located in the surroundings of vital parts of the brain, major blood vessels and nerves, so adenoma leads to severe neurological and endocrinological effects. Nevertheless, this tumor is often treatable, the main thing - in time to see a doctor. Says Professor, MD, director of the Federal Center of Neurosurgery Pain RF Ministry of Health Yury Grigoryan.
Pituitary adenoma develops directlypituitary tissue, which is on the base of the brain. Pituitary consists of two parts: the front (anterior pituitary) and rear (neurohypophysis). Most often, the tumor develops in the front. Usually people with this disease face in the age of 20-40 years, and men and women with equal frequency. The pituitary gland controls the endocrine system: controls the metabolism, the production of thyroid hormones, sex hormones, regulates the growth process, the function of the adrenal tumors, etc. lead to a breach of diverse functions... Manifested pituitary adenoma mainly two types of violations: and endocrine tumor arising from the compression of adjacent brain structures.
Most pituitary adenomas themselves producehormones. For example, if the growth hormone is produced, the developing gigantism. High growth, enlarged hands, large features can serve as an indirect indication of the presence of pituitary adenoma. Suffers first appearance, people start to notice that you have to wear gloves, shoes larger. This leads them to the doctor.
If the tumor produces the hormone prolactin, itmanifest sexual dysfunction. The men - decreased sex drive, impotence. In women, the menstrual cycle changes, secrete milk from the mammary glands; the result of all these disturbances - infertility.
Of great importance is the size of the tumor. Adenomas are divided into microadenomas (less than one centimeter) and macroadenoma (more than a centimeter).
But this endocrine tumor activity, ie. E. increased production of hormones, regardless of size. It may be small (a few millimeters) and manifest severe endocrine disorders, and sometimes vice versa. Tumor size is important for another reason. Macroadenoma with increasing compress the optic nerves, which are located above the pituitary gland. This leads to a decrease in the severity and impaired visual fields: the original suffering side visibility, and then may develop irreversible blindness. Spreading the sides, swelling interfere with the function of the cranial nerves that control eye movement, and a person has the feeling of duality, strabismus may - drooping eyelids. If the tumor is very large, it can compress the third ventricle (education, located above the pituitary gland) and violate the free circulation of cerebrospinal fluid within the brain. This leads to a syndrome of increased intracranial pressure, accompanied by severe headache, vomiting, and requires emergency surgery.
Pills or surgery?
To make the correct diagnosis in the first place,estimated vision. The surest method of confirmation of an adenoma - a MRI (magnetic resonance imaging) of the brain, which will show the size of the tumor, its characteristics, the presence of cysts in it. Plus clarity makes further study of hormone levels in the blood.
For example, in the case of prolactinomas, especiallyit is of small size, the first phase can help medicines. Normalizes hormone levels, the woman recovers the menstrual cycle, she can get pregnant and give birth to a healthy baby. But after tumor drugs only decreases every fifth patient. Therefore, to date, the ideal treatment of pituitary adenomas - surgery.
Pituitary tumors are removed without cutting through the nose,under anesthesia. Be sure to use an operating microscope, microsurgical instruments. Because such operations need good equipment and highly skilled, they performed only in big hospitals. Although complex operation, most patients it is easy enough to tolerate.
If a very large pituitary adenoma, is craniotomy, which is needed more often in advanced cases with sharp visual impairment, including blindness.
Recently, an opportunitysurgery (especially small adenoma) using endoscopic techniques. At the same time, there are two options for tumor removal. First - microsurgical operation through the nose using a microscope and an endoscope is used in addition to control and confirm the removal of the tumor. Second Embodiment - endoscopic completely when the endoscope is inserted through a nostril, is connected to the TV system and using microsurgical instruments introduced through the working channels of the endoscope is removed adenoma.
And then what?
Many patients are concerned about - is restoredWhether lost vision? Experts meet at him. If there is a breach of a long time - a few months or a year, the probability of recovery of normal vision small. The task of the surgeon - to keep at least what's left. If the violation occurred recently, that vision (almost one third of patients) is recovered in the first few days after surgery. The sharp deterioration in the result of bleeding in the tumor can only improve the surgeon's urgent intervention. In any case, the sooner you see a doctor, the more likely a positive outcome.
The larger the tumor, the more important lifebrain structures, it hurts, the more the risk of circulatory disorders in the intervention area. This may be accompanied by severe metabolic disorders, especially water-salt balance, as well as the development of cerebral infarction. So-called "diabetes insipidus" appears insatiable craving and significant release of urine - from 6 to 20 liters per day. In most cases, this is easily corrected using artificial hormone in the form of powders or drops for instillation into the mouth or nose. As a result of the removal of microadenoma may decrease the concentration of essential hormones, and then have to either temporarily or permanently fill their lack of medicines. Speaking of all these complications, it is necessary to remember that the percentage of the total number of operations quite low.
Another method of treating pituitary adenoma - isradiation therapy. The downside is that the irradiation of the pituitary gland, surrounding the optic nerves, and other structures of the brain can cause permanent vision loss after months or even years. The fact that it is impossible to isolate one portion of the pituitary gland, will inevitably suffer, and other of its share. Therefore it is considered in the world, that radiation therapy should be used only after attempting to correct and endocrinological surgery at microadenomas, and only after the operation - for macroadenomas. I needed it and when the patient for various reasons is contraindicated anesthesia and carry out the operation impossible.
Sometimes after a few months or even yearsthe tumor starts to grow again from the remaining cells. If medications do not help, you may need another operation. Although if you re only visible adenoma on MRI, the size of its small and it "does not prevent" man, it does not need to touch. It requires only control tumor size and doctor monitor the general condition of the patient.