If a woman has a disruption of the menstrual cycle, Lactoria (selection of white (similar to milk) fluid from the mammary glands), infertility, it is necessary to check whether there is no adenoma pituitary.
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Adenoma pituitary gland — Hidden and dangerous
Where it comes from, it's hard to say. Therefore, to prevent its development, identify a reliable cause of the occurrence and predict the course of the disease. Modern medicine cannot. The pituitary is located surrounded by vital sections of the brain, large vessels and nerves, so adenoma leads to severe endocrinological and neurological consequences. Nevertheless, this tumor in many cases is treatable, the main thing — turn to the doctor. Professor, Doctor of Medical Sciences, Head of the Federal Center for Neurosurgery of Pain MH of the Russian Federation Yuri Alekseevich Grigoryan.
The adenoma pituitary is developing directly in the pituitary tissue, which is on the basis of the brain. The pituitary is from two parts: anterior (adenogipid) and rear (neurohypophysis). Most often, the tumor is developing in front. Usually with this disease people face aged 20–40 years old, and men and women with the same frequency. The pituitary is controlled by endocrine systems: controls the metabolism, the production of thyroid hormones, sex hormones, regulates the growth process, the function of the adrenal glands and T. D. Tumors lead to violation of these diverse functions. The adenoma of the pituitary is manifested mainly by two types of disorders: endocrine and arising from the squeezing of the tumor of the adjacent brain structures.
Most of the pituitary adena themselves produce hormones. For example, if growth hormone is produced, hygantism develops. High growth, enlarged handbrushes, large features of the face can serve as an indirect indication for the presence of the pituitary adenoma. It suffers first of all appearance, people begin to notice that you have to wear gloves, larger shoes. This leads them to a doctor.
If the tumor produces a hormone prolactin, this is manifested by a violation of sexual functions. In men — decline in sexual entry, impotence. The women change the menstrual cycle, milk from the mammary glands is distinguished; The result of all these violations — infertility.
Size matters
The size of the tumor is of great importance. Adenoma are divided into microenomes (less than one centimeter) and macroenomes (more centimeter).
But at the same time, the endocrine activity of the tumor, T. E. Increased hormone production, does not depend on the size. It can be small (several millimeters) and manifest themselves heavy endocrine disorders, and it happens on the contrary. The magnitude of the tumor matters for another reason. Macroenomes as they grovely squeeze the visual nerves that are above the pituitary. This leads to a decrease in the severity and impaired fields: initially suffering lateral visibility, and then irreversible blindness can also develop. Spreading to the sides, the tumor disrupts the function of the cranial and brain nerves, controlling the movement of the eyes, and the person has a feeling of splitness, squint, possibly — Outstanding. If the tumor is very large, it can squeeze the third ventricle (the formation located above the pituitary) and disrupt the free circulation of the spinal cord fluid inside the brain. This leads to an increased intracranial pressure syndrome, accompanied by severe headache, vomiting and requires an urgent operation.
Tablets or operation?
To put the correct diagnosis, firstly, the vision is estimated. The most reliable adenoma confirmation method — This is an MRI (magnetic resonance tomography) of the brain, which will show the size of the tumor, its features, the presence of a cyst. Plus Clarity makes an additional study of the level of hormones in the blood.
For example, in the case of prolactine, especially if it is small, medicines can help at the first stage. The level of hormones is normalized, the woman has a menstrual cycle, it can get pregnant and give birth to a healthy child. But after drugs, the tumor decreases only in each fifth patient. Therefore, today the ideal of the treatment of adenoma pituitary — surgical intervention.
The pituitary tumors are removed without cut through the nose, under anesthesia. Operational microscope, microsurgical instruments are necessarily used. Since there are good equipment and highly qualified specialists for such operations, they are performed only in large medical institutions. Despite the fact that the operation is complicated, most patients have easily transferred it enough.
If the pituitary adenoma is very big, the trepanation of the skull is made, which is most often needed in the launched cases with sharp impaired violations, up to blindness.
Recently, an operation has appeared (especially if the adenoma is small) using endoscopic technology. In this case, there are two versions of tumor removal. First — Microsurgical operation through the nose with a microscope, and the endoscope is used additionally to control and confirm the removal of the tumor. Second option — Fully endoscopic when an endoscope is introduced through the nostril, connected to television systems, and with the help of microsurgical instruments entering the endoscope, adenoma is removed.
And that later?
Many patients are concerned about the question — Will the lost vision restore? Specialists respond to him so. If violation of vision exists long enough — A few months or about a year, the probability of restoring normal vision is small. Task Surgeon — Save at least what remains. If the violation occurred recently, the vision (almost one third of the patients) is restored in the first days after the operation. A sharp deterioration as a result of hemorrhage into a tumor can only be corrected by urgent surgeon intervention. In any case, the sooner you consult a doctor, the greater the likelihood of a positive outcome.
The greater the tumor, the more important life structures of the brain, it hurts, the greater the risk of circulatory disorders in the intervention zone. This may be accompanied by a severe metabolic disorder, in particular the water-salt balance, as well as the development of the brain infarction. So-called «Nonachar diabetes» manifests itself to non-violent thirst and significant urine release — from 6 to 20 liters per day. In most cases, it is easily corrected using artificially created hormones in the form of powders or droplets for injection into mouth or nose. As a result of the removal of microenomes, the concentration of the necessary hormones may decrease, and then will have to temporarily or constantly fill their lack of drugs. Speaking of all these complications, you need to remember that their percentage of the total number of operations is completely low.
Again grow
Another way to treat adenoma pituitary — This is radiation therapy. The lack of it is that the irradiation of the pituitary glands adjacent to it the visual nerves and other structures of the brain can lead to an irreversible impact of vision months and even years. The fact is that it is impossible to isolate one pituitary area, the other shares will inevitably suffer. Therefore, in world practice it is believed that radiation therapy should be used only after attempts by endocrinological correction and surgical intervention in microenomes, and only after surgery — With macroenoma. It is necessary and then, when the patient for various reasons is contraindicated anesthesia and it is impossible to carry out the operation.
Sometimes after a few months or even years old, the tumor again begins to grow from the remaining cells. If medications do not help, you may need another operation. Although if the repeated adenoma is visible only on MRI, its size is small and she «Does not interfere» man, she does not need to touch. Only control of the sizes of the tumor and the observation of the doctor over the common state of the patient.
