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| {{Infobox_Disease |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| Name = {{PAGENAME}} |
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| Image = Illu pituitary pineal glands.jpg |
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| Caption = |
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| DiseasesDB = |
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| ICD10 = {{ICD10|D|35|2|d|10}} |
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| ICD9 = {{ICD9|237.0}} |
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| ICDO = {{ICDO|8140|0}} |
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| OMIM = |
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| MedlinePlus = 000704 |
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| eMedicineSubj = neuro |
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| eMedicineTopic = 312 |
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| MeshID = D010911 |
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| }}
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| {{SI}} | | {{Pituitary adenoma}} |
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| {{CMG}} | | {{CMG}} {{AE}} {{AAM}} |
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| {{Editor Help}} | | {{SK}}: Pituitary macroadenoma; Pituitary microadenoma; Pituitary adenomas, Adenoma of the pituitary gland; Pituitary non-functioning adenoma; Gonadotropic adenoma; Thyrotropic adenoma; TSH-oma; Plurihormonal pituitary adenoma; Null cell adenomas |
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| '''Pituitary adenomas''' are [[tumor]]s that occur in the [[pituitary gland]], and account for about 10% of intracranial [[neoplasia|neoplasms]]. They often remain undiagnosed, and small pituitary tumors are found in 6 to 24 percent of adults at autopsy.
| | ==[[Pituitary adenoma overview|Overview]]== |
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| Pituitary adenomas arise within the anterior lobe (adenohypophysis) of the gland . Tumors less than 1 cm are called micro adenomas. Clinical symptoms depend on whether the tumor is secreting or nonsecreting. Nonsecreting adenomas grow and compress adjacent structures, most commonly causing a bitemporal hemianopsia due to chiasmatic compression. Lateral extension into the cavernous sinuses can result in cranial nerve palsies. | | ==[[Pituitary adenoma historical perspective|Historical Perspective]]== |
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| ==Types== | | ==[[Pituitary adenoma classification|Classification]]== |
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| Pituitary tumors were, historically, classed as [[basophilic]], [[Acidophile|acidophilic]], or [[chromophobic]] on the basis of whether or not they took up the stains [[hematoxylin]] and [[eosin]]. This classification has fallen into disuse, in favor of a classification based on what type of [[hormone]] is secreted by the tumor (though tumors which do not secrete any active hormone ("non-functioning tumors") are still sometimes called "chromophobic").
| | ==[[Pituitary adenoma pathophysiology|Pathophysiology]]== |
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| At present, classification of pituitary tumors is based on plasma hormone levels or [[immunohistochemical staining]]:
| | ==[[Pituitary adenoma causes|Causes]]== |
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| {| class="wikitable"
| | ==[[Pituitary adenoma differential diagnosis|Differentiating Pituitary adenoma from other Diseases]]== |
| | '''Type of adenoma''' || '''Secretion''' || '''Staining''' || '''Pathology'''
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| | ''[[corticotrophic]] adenomas'' || secrete adrenocorticotropic hormone ([[ACTH]]) and pro-opiomelanocortin ([[POMC]]) || [[Anterior pituitary basophil|basophilic]] || [[Cushing's disease]]
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| | ''[[somatotrophic]] adenomas'' || secrete growth hormone ([[GH]]) || [[Acidophile (histology)|acidophilic]] || [[acromegaly]] (gigantism)
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| | ''[[thyrotrophic]] adenomas'' (rare) || secrete thyroid-stimulating hormone ([[TSH]]) || [[Anterior pituitary basophil|basophilic]] || occasionally [[hyperthyroidism]]{{ref|thyrotrophic}}, usually doesn't cause symptoms
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| | ''[[gonadotrophic]] adenomas'' || secrete luteinizing hormone ([[LH]]), follicle-stimulating hormone ([[FSH]]) and their subunits || [[Anterior pituitary basophil|basophilic]] || usually doesn't cause symptoms
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| | ''[[lactrotrophic]] adenomas'' or ''[[prolactinoma]]s'' (most common) || secrete [[prolactin]] || [[Acidophile (histology)|acidophilic]] || [[galactorrhea]], [[hypogonadism]], [[amenorrhea]], [[infertility]], and [[impotence]]
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| | ''[[null cell]] adenomas'' || do not secrete hormones || may stain positive for [[synaptophysin]] ||
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| |}
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| ==Diagnosis== | | ==[[Pituitary adenoma epidemiology and demographics|Epidemiology and Demographics]]== |
| The diagnosis is generally entertained either on the basis of visual difficulties arising from the compression of the [[optic nerve]] by the tumor, or on the basis of manifestations of excess hormone secretion: the specifics depend on the type of hormone. The specific area of the visual pathway at which compression by these tumours occurs is at the [[optic chiasma]].
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| | ==[[Pituitary adenoma risk factors|Risk Factors]]== |
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| The anatomy of this structure causes pressure on it to produce a defect in the temporal visual field on both sides, a condition called [[bitemporal hemianopsia|bitemporal hemianopia]].
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| Tumors which cause visual difficulty are likely to be ''macroadenomata'' greater than 10 mm in diameter; tumors less than 10 mm are ''microadenomata''.
| | ==[[Pituitary adenoma natural history, complications, and prognosis|Natural History, Complications and Prognosis]]== |
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| Some tumors secrete more than one hormone, the most common combination being GH and prolactin.
| | ==Diagnosis== |
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| Prolactinomas are frequently diagnosed during pregnancy, when the [[hormone]] [[progesterone]] increases the tumor's growth rate.
| | [[Pituitary adenoma history and symptoms|History and Symptoms]] | [[ Pituitary adenoma physical examination|Physical Examination]] | [[Pituitary adenoma laboratory tests|Laboratory Findings]] | [[Pituitary adenoma CT|CT]] | [[Pituitary adenoma MRI|MRI]] | [[Pituitary adenoma echocardiography or ultrasound|Ultrasound]] | [[Pituitary adenoma other imaging findings|Other Imaging Findings]] | [[Pituitary adenoma other diagnostic studies|Other Diagnostic Studies]] |
| Headaches may be present. The diagnosis is confirmed by testing hormone levels, and by radiographic imaging of the pituitary (for example, by [[CT scan]] or [[MRI]]).
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| ==Treatment== | | ==Treatment== |
| | [[Pituitary adenoma medical therapy|Medical Therapy]] | [[Pituitary adenoma surgery |Surgery]] | [[Pituitary adenoma primary prevention|Primary Prevention]] | [[Pituitary adenoma secondary prevention|Secondary Prevention]] | [[Pituitary adenoma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pituitary adenoma future or investigational therapies|Future or Investigational Therapies]] |
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| Treatment options depend on the type of tumor and on its size:
| | ==Case Studies== |
| * '''[[Prolactinoma]]s''' are most often treated with [[bromocriptine]] or more recently, [[cabergoline]] which, unlike bromocriptine, decreases tumor size as well as alleviates symptoms, both dopamine agonists, and followed by serial imaging to detect any increase in size. Treatment where the tumor is large can be with [[radiation therapy]] or surgery, and patients generally respond well. Efforts have been made to use a progesterone [[antagonist]] for the treatment of prolactinomas, but so far have not proved successful.
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| * '''Thyrotrophic adenomas''' respond to [[Somatostatin|octreotide, a long-acting somatostatin analog]], in many but not all cases according to a review of the medical literature. Unlike prolactinomas, thyrotrophic adenomas characteristically respond poorly to dopamine agonist treatment.{{ref_label|thyrotrophic|1|a}}
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| ==References== | |
| # {{note|thyrotrophic}}{{note_label|thyrotrophic|1|a}} Chanson, Philippe; Weintraub, Bruce D.; and Harris, Alan G. (1993) [http://www.annals.org/cgi/content/full/119/3/236 Octreotide Therapy for Thyroid-Stimulating Hormone-Secreting Pituitary Adenomata]. ''Annals of Internal Medicine'' '''119''' (3), 236-240.
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| ==See Also==
| | [[Pituitary adenoma case study one|Case #1]] |
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| | ==Related Chapters== |
| * [[Adult brain tumors]] | | * [[Adult brain tumors]] |
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| ==External links== | | ==External links== |
| * [http://www.cancer.gov/cancertopics/types/pituitary/ Cancer.gov: pituitary tumors] | | * [http://www.cancer.gov/cancertopics/types/pituitary/ Cancer.gov: pituitary tumors] |
| * Case report of [http://clinicalcases.blogspot.com/2004/05/bilateral-hemianopsia-due-to-pituitary.html Bilateral Hemianopsia Due to Pituitary Adenoma]. Clinical Cases and Images.
| | {{WikiDoc Help Menu}} |
| * [http://www.netterimages.com/image/7280.htm Medical Illustration of Pituitary Adenomas by Frank H. Netter]
| | {{WikiDoc Sources}} |
| | | [[Category:Disease]] |
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| {{SIB}} | |
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| [[cs:Adenom hypofýzy]]
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| [[nl:Hypofysetumor]]
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| [[sk:Adenóm hypofýzy]]
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| [[sv:Hypofystumör]]
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| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
| [[Category:Oncology]] | | [[Category:Oncology]] |
| | | [[Category:Mature chapter]] |
| | | [[Category:Up-To-Date]] |
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| | [[Category:Oncology]] |
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| | [[Category:Medicine]] |
| | [[Category:Neurology]] |
| | [[Category:Neurosurgery]] |
| | [[Category:Endocrinology]] |