Pituitary Adenoma

Pituitary tumours represent 10-15% of all intracranial tumours and are usually benign. They arise from the anterior pituitary and rarely grow infiltrative into surrounding tissue.

Histology of Pituitary Tumours

usually slowly growing tumours (WHO grade I)
also higher graded tumours can occur
arise from anterior pituitary
there are hormon-active (e.g. prolactinoma) and hormon-inactive pituitary tumours
according to their localisation and features they are graded from A to E

Epidemiology of Pituitary Tumours

usually in adult age, rarely in children
represent 10-15% of all intracranial tumours

Symptoms of Pituitary Tumours

disturbed vision and restriction of visual field (in serious cases loss of sight)
hemiparesis
headache
rarely epileptic seizures
symptoms of hormon-active tumours depend on impact of the single hormons (e.g. Cushing´s disease)
hormon-inactive tumours can cause hormon-related deficiency symptoms (e.g. anaemia, fatigue, avolition)

Diagnosing Pituitary Tumours

with CT or MRI with contrast agent
frequently hemorrhages
usually clearly defined tumours
endocrinological diagnostics in order to differentiate between hormon-active and hormon-inactive tumours

Therapy of Pituitary Tumours

hormon-inactive pituiatry tumours:

surgical removal (usually transnasal)
postoperative control of residual pituitary function
if complete resection is not possible, usually additional radiotherapy
no drug treatment necessary

hormon-active pituitary tumours:

prolactinoma are treatet with dopamine agonists (as permanent therapy)
hormon therapy frequently replaces surgery
hormon-active tumours usually respond to drug treatment

Therapy of Recurrent Pituitary Tumours

if possible (re-)operation
possibly (second) irradiation (single exposure or fractionated)

Aftercare of Pituitary Tumours

requires coorporation between neuro surgeons and endocrinologists
for hormon-inactive tumours: CT or MRI once a year
for hormon-active tumours: regular measurements of hormons, if hormons increase MRI or CT

Course of Pituitary Tumours

hormon-inactive tumours:

become first conspicuous when they interfere with sourrounding environment
because of then possibly already existing infiltration of surrounding tissue they can not always be compleetly removed in surgery
tend to relapse

hormon-active tumours:

80-90% of patients respond to drug treatment
rarely recurrences after discontinue of drugs

Prognosis of Pituitary Tumours

with the established treatment hormon-inactive tumours can ususally be controlled in the long term
with adequate therapy in good time hormon-active tumours have a good prognosis too