In many cases, the individuals experience no symptoms if the tumor has not grown in size. In the rest, pituitary adenomas present the following signs and symptoms:

• Cushing’s syndrome
• Hyperthyroidism
• Decreased sexual function in males
• Changes in vision
• Lethargy
• Acromegaly [4]
• Fatigue
• Headache
• Nausea accompanied by vomiting
• Nasal discharge
• Nipple discharge

• Fatigue

  […] of depression, fatigue, or apathy. [doi.org]

  Here we describe the unusual case of a 60-year-old man who presented with progressive fatigue and polyuria, and whose laboratory workup revealed a deficiency of the five hormones associated with the action of the anterior pituitary (thyroid hormone, testosterone [ncbi.nlm.nih.gov]

  Manifestations may include hypogonadism (sexual dysfunction, loss of libido, and impotence), hypothyroidism (fatigue, weakness, weight gain, coarse dry hair and dry skin, cold intolerance, depression), adrenal insufficiency (fatigue, weakness, loss of [pacificneuroscienceinstitute.org]

  […] and decreased mental function Adrenal insufficiency which can cause fatigue, low blood pressure, electrolyte abnormalities Growth hormone insufficiency which can cause delayed puberty and in adults tiredness and loss of muscle mass The size of the tumour [thebraintumourcharity.org]

• Weakness

  Eight days after the surgery, she suffered from acute onset general weakness and nausea/vomiting. She was diagnosed with hyponatremia for which she was treated. [ncbi.nlm.nih.gov]

  Manifestations may include hypogonadism (sexual dysfunction, loss of libido, and impotence), hypothyroidism (fatigue, weakness, weight gain, coarse dry hair and dry skin, cold intolerance, depression), adrenal insufficiency (fatigue, weakness, loss of [pacificneuroscienceinstitute.org]

  […] or depression Changes to the face (for example, teeth may move further apart) Dizziness Headaches Erectile dysfunction (in men) Irregular menstrual cycles (in women) Growth of your skull, hands and feet Vision problems Unexplained changes in weight Weakness [aurorahealthcare.org]

  The results could be growth failure in children (growth hormone deficiency), delayed puberty or loss of sexual function or infertility or menstrual irregularities (low reproductive hormones), weakness fatigue and weight loss (low cortisol), and hypothyroidism [openanesthesia.org]

• Anemia

  Evans' syndrome was diagnosed based on idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia. She had a history of malocclusion and thyroid gland enlargement 4 years prior to admission. [ncbi.nlm.nih.gov]

  Anemia, fatigue, lethargy, menstrual disorders, libido and sexual disorders, constipation or symptoms of hypothyroidism (underactive thyroid) can also occur. [ims.uniklinik-freiburg.de]

  Other symptoms include the following: Diastolic apical rumbling murmur (mimicking mitral stenosis) Holosystolic murmur best heard at apex and radiating to axilla (mitral regurgitation) Tumor "plop" Systemic: Fever Clinical signs of anemia Weight loss [emedicine.medscape.com]

  Prolactinoma : high prolactin is not known to shorten life; however loss of normal testosterone production in men causes a risk of osteoporosis, increases the risk for bone fractures, loss of muscle mass, anemia (low red blood cell count) and fatigue. [med.virginia.edu]

• Short Stature

  Duplication of Xq26.2-q27.1, including SOX3, in a mother and daughter with short stature and dyslalia. Am J Med Genet A 2005 ;138: 11 - 17 19. Zhang F, Khajavi M, Connolly AM, Towne CF, Batish SD, Lupski JR. [doi.org]

  Growth hormone-secreting adenomas can increase ICP in a fashion similar to those in children taking growth hormone for short stature or patients with Turner syndrome who develop idiopathic intracranial hypertension. [eyewiki.aao.org]

  Loss of growth hormone in children causes lack of normal growth (growth retardation, short stature). In adults, symptoms of decreased energy and vitality are common. [med.virginia.edu]

• Constitutional Symptom

  A detailed review of systems focusing on endocrinologic and constitutional symptoms may guide the diagnosis. Patients with secretory tumors may have systemic complaints that are associated with their corresponding hormonal imbalance. [eyewiki.aao.org]

• Rhinorrhea

  After the surgery the patient recovered well except developing cerebrospinal fluid rhinorrhea, which was controlled by lumbar drainage. MRI 6 months later did not show any sign of progression. [ncbi.nlm.nih.gov]

  Clinical manifestations include AMENORRHEA; GALACTORRHEA; IMPOTENCE; HEADACHE; visual disturbances; and CEREBROSPINAL FLUID RHINORRHEA. [fpnotebook.com]

  They also tend to occur insidiously, so that many patients are not aware of them until they are specifically tested. 15 Other neurologic presentations, such as cerebrospinal fluid rhinorrhea, seizures, and pituitary apoplexy, can occur but are uncommon [aafp.org]

• Anosmia

  Tumor extension to the septum pellucidum or the frontal lobes may result in cognitive deficit or psychiatric symptoms and in anosmia if cranial nerve I is affected. [doi.org]

• Diplopia

  CASE DESCRIPTION: We present the case of a 63-year-old woman with remote history of Staphylococcus osteomyelitis who presented with 1 week of diplopia, partial left third nerve palsy, and bitemporal hemianopsia who was found to have a pituitary abscess [ncbi.nlm.nih.gov]

  Patients will often complain that they have trouble with anteroposterior tasks such as cutting fingernails, threading needles, and working with precision tools. [23] Diplopia Diplopia may be due to cranial nerve paresis from lateral extension of tumors [eyewiki.aao.org]

  Subsequently, he developed diplopia, bitemporal hemianopsia, and a right third nerve palsy. He recently had 1 bout of hematuria following exercise. His physical examination was otherwise unrevealing. [doi.org]

  These tumors generally are too small to cause pain, diplopia, or pressure on the optic chiasm. Otherwise-normal anterior and posterior pituitary function remains intact. Any morbidity is caused by excessive hormone secretion [8] or patient anxiety. [emedicine.medscape.com]

• Visual Impairment

  VA, VF, preoperative visual impairment score (VISpre) and postoperative visual impairment score (VISpost) were determined. [ncbi.nlm.nih.gov]

• Arthralgia

  The systemic symptoms (eg, fever, arthralgia, elevated sedimentation rate, lupuslike rashes) that accompany some myxomas may be due to the production of the proinflammatory cytokine interleukin-6 by the myxoma. [emedicine.medscape.com]

  Osteoarthritis and arthralgia. (Refer to the PDQ summary on Cancer Pain for more information.) Excessive sweating. (Refer to the PDQ summary on Hot Flashes and Night Sweats for more information.) Dysmorphophobia. [cancer.gov]

• Nipple Discharge

  They typically include symptoms such as abnormal nipple discharge of milk (galactorrhea) and reproductive dysfunction. [lucasresearch.org]

  In the rest, pituitary adenomas present the following signs and symptoms: Cushing’s syndrome Hyperthyroidism Decreased sexual function in males Changes in vision Lethargy Acromegaly Fatigue Headache Nausea accompanied by vomiting Nasal discharge Nipple [symptoma.com]

  discharge and irregular or absent menstrual periods in women Decreased sexual function in men Symptoms caused by pressure from a larger pituitary tumor may include: Changes in vision such as double vision, visual field loss (loss of peripheral vision [nlm.nih.gov]

  Prolactinoma and nonfunctioning pituitary adenoma: infertility amenorrhea (absence of menses or menstrual periods) oligomenorrhea (irregular/sparse menstruation) decreased libido (interest in sex) galactorrhea (breast milk production / leakage / nipple [pituitary.mgh.harvard.edu]

• Loss of Libido

  A 55-year-old patient presented for erectile dysfunction, loss of libido and fatigue. The biochemical evaluation showed very high FSH serum levels in the presence of central hypogonadism. [ncbi.nlm.nih.gov]

  Postoperative complications include hormone deficiencies such as low ACTH (secondary adrenal insufficiency) characterized by low cortisol, low blood pressure, low blood sugar, hair loss, and loss of libido. [innerbody.com]

  […] of libido, vaginal dryness Men: loss of libido, erectile dysfunction, infertility Growth hormone (~25%) Acromegaly : bone enlargement in hand/feet/skull, prominent jaw, cardiomegaly, heat intolerance, weight gain ACTH (~20%) Cushing's disease : central [en.wikibooks.org]

  Manifestations may include hypogonadism (sexual dysfunction, loss of libido, and impotence), hypothyroidism (fatigue, weakness, weight gain, coarse dry hair and dry skin, cold intolerance, depression), adrenal insufficiency (fatigue, weakness, loss of [pacificneuroscienceinstitute.org]

• Anxiety Disorder

  Numerous psychiatric illnesses, including major depressive disorder, generalized anxiety disorder, and dysthymia are frequently associated with fatigue. [doi.org]

• Seizure

  Median time to CR 1.5 years Toxicity: New pituitary deficits 52%; no optic nerve damage, seizure or brain injury Conclusion: Proton SRS effective for persistent ACTH-secreting adenomas, with low morbidity Loma Linda; 2006 (1991-2001) PMID 16257131 -- [en.wikibooks.org]

  They can also cause temporal lobe seizure, hydrocephalus from compression of foramen of Monro or the aqueduct of sylvius, or even symptoms resulting from compression of the brain stem [ 3 ]. [omicsonline.org]

  Extremely large pituitary tumors can even cause pressure on the brain, leading to seizures or blockage of the normal flow of cerebrospinal fluid (a condition called hydrocephalus, or “water on the brain”). [urmc.rochester.edu]

  86 45.2 Cognitive/psychiatric deficit 5 2.6 Cranial nerve II deficit 53 27.9 SIADH 3 1.5 Anterior pituitary insufficiency (partial or total) 45 23.6 Cerebral hemorrhage 3 1.5 Cranial nerve V dysfunction 3 1.5 Cranial nerve III, IV, VI palsy 41 21.6 Seizures [doi.org]

• Agitation

  On postoperative day 4, the patient exhibited an elated mood, grandiose delusions, anxiety, and agitation. We diagnosed these psychiatric symptoms as steroid psychosis induced by steroid replacement and we prescribed risperidone as a treatment. [ncbi.nlm.nih.gov]

  […] stabs Very severe – + + – Nasal block, ptosis Acro = acromegaly; Macro = macroadenoma; Mvt = headache worsened with physical activity; NFA = non-functioning adenoma; phono = phonophobia; photo = photophobia; Prolactin = prolactinoma; R = restless or agitated [doi.org]

• Amenorrhea

  A 46-year-old woman presented with visual loss and amenorrhea. [ncbi.nlm.nih.gov]

  Typical presenting manifestations include amenorrhea, infertility, visual field abnormalities, and headache. Diagnosis is often made with brain MRI, visual field testing, and serum hormone assay. [medlink.com]

• Sexual Dysfunction

  Manifestations may include hypogonadism (sexual dysfunction, loss of libido, and impotence), hypothyroidism (fatigue, weakness, weight gain, coarse dry hair and dry skin, cold intolerance, depression), adrenal insufficiency (fatigue, weakness, loss of [pacificneuroscienceinstitute.org]

  In men, symptoms of this type of prolactinoma are usually limited to sexual dysfunction and the general symptoms we discussed earlier in this lesson. [study.com]

  dysfunction Infertility Fatigue (extreme tiredness) Unexplained weight gain or loss Achy joints or muscle weakness Early menopause Changes in your monthly periods (women) [my.clevelandclinic.org]

The following tests will be done to diagnose pituitary adenomas:

• Blood and urine tests to determine the levels of hormones.
• Vision test to determine the eye sight which would confirm whether the tumor has affected the eyes.
• Imaging studies such as MRI and CT scan of the brain that would help determine the size as well as the exact location of the tumor. Intraoperative MRI may be used during surgery to prevent unexpected tumor remnants from being left behind [5].
• Several tests to determine the functioning of the endocrine system will also be done.

• Enlarged Sella

  ( PMID 945663 ), not uniformly accepted Grade 0: Intrapituitary microadenoma with normal sellar appearance Grade I: Normal-sized sella (15 × 12 mm) with asymmetry of the floor Grade II: Enlarged sella with an intact floor Grade III: Localized erosion [en.wikibooks.org]

• Prolactin Increased

  If the medication is stopped, the prolactin will usually increase and the tumor will also increase in size. This is similar to a person who has high blood pressure. [med.virginia.edu]

There are several factors that determine the type of treatment to be employed for pituitary adenomas. The size of the tumor, its location, age of the individual and overall health all need to be taken into consideration before deciding the treatment plan. The following methods are employed for treating pituitary adenomas:

• Surgery is often the first line of treatment even in adenomas that appear inactive [6]. It is required if the tumor has grown in size and is exerting pressure on the optic nerve. In majority of the cases, the tumor is removed through nose or sinuses. Such a type of surgical procedure is known as endoscopic transnasal transphenoidal approach [7]. An alternate nasal surgical approach known as the extended endoscopic endonasal approach (EEEA) is implored in difficult cases of resection [8]. Another surgical procedure that is done when the former method cannot be used is the transcranial approach. 
• Radiation therapy is done when surgery is not possible. The rays cause the tumor to shrink in size. Neuroscience research have identified the use of fractionated steriotactic radiation therapy (FSRT) to be very effective in the treatment of pituitary adenomas [9]. The use of a gamma knife may prevent the incidence of post-radiation panhypopituitarism in treated patients [10].
• Medications are also given to shrink the tumors.
• In instances, when the size of the tumor is small, then no interventions are carried out and the patient is called for yearly examination of the tumor through MRI and CT scan. 

Pituitary adenomas are benign tumors that can cause serious complications if not treated on time. If the tumors remain small in size and do not grow then the individuals would seldom experience any symptoms. Prognosis is generally good if treatment is initiated at the right time. In addition, if the entire tumor is removed then outcome is favorable.

Complications

Pituitary adenomas can cause the following life threatening complications:

• Blindness if the tumor damages the optic nerve
• Permanent hormonal imbalances in post radiation panhypopituitarism [2]
• Diabetes insipidus 
• Pituitary apoplexy characterized by sudden bleeding of the tumor
• Cerebrovascular disease or stroke [3]

The abnormal growth of cells in the pituitary gland gives rise to the condition known as pituitary adenomas. The exact phenomenon that triggers the growth of cells in an abnormal fashion is yet to be identified.

Pituitary adenomas are not inherited and occur spontaneously. However, there are small pieces of evidence backed up with clinical studies that suggest heredity as a factor for development of adenomas. But, this happens in very rare cases. Researches have implicated pituitary adenomas as a defect in gene mutation [1]. Individuals suffering from multiple endocrine neoplasia type 1 (MEN 1) also suffer from pituitary adenomas as a secondary complication.

Pituitary adenomas are a common condition affecting individuals across the globe. It has been estimated that about 1 in every 5 adults develop tiny tumors in the pituitary gland. In majority of the cases, the tumors do not grow in size and cause no problems as well. However, these are diagnosed when individuals undergo imaging studies of the brain for some other complaint.

Pituitary gland is located at the base of the brain and is known as the master gland as it regulates the hormonal balance of the body. Benign tumors that develop in this gland are known as pituitary adenomas. The development of tumors in this gland damages the normal hormone producing cells of pituitary. This in turn disrupts the body’s hormonal balance which triggers several other conditions disturbing the body’s normal functioning.

The pituitary gland releases hormones such as prolactin, growth hormones, thyroid stimulating hormone, luteinizing hormone, follicle stimulating hormone and adrenocorticotropic hormone.

So far no guidelines have been given to prevent the development of pituitary adenomas. The exact cause that triggers the development of tumors is unknown and therefore it is difficult to prevent this disease condition.

Pituitary adenomas are tumors of the pituitary gland. These tumors are benign in nature and generally do not cause any harm. It has been estimated that about 10% cases of pituitary adenomas go undiagnosed. The individuals are also unaware of the tumor development as it does not produce any significant symptoms.

The pituitary gland is the part of the brain that regulates the body hormonal balance. Therefore, disorders of this gland can cause an imbalance in its hormonal regulation activity. There are several types of pituitary adenomas that are classified on the basis of size, hormone secretion and aggressiveness of the tumors.

Definition

Tumors that develop in the pituitary gland are termed as pituitary adenomas. These are benign in nature and in many cases go undiagnosed as the tumors do not cause any symptoms. It has been estimated that probably about 10% of individuals have pituitary adenomas and would not even know about it. Tumors in the pituitary gland gravely affect the body’s hormonal balance.

Cause

The exact mechanism that triggers the uncontrolled growth of cells in the pituitary gland is yet to be figured out. Pituitary adenomas often occur as a secondary complication to MEN 1.

Symptoms

Symptoms of pituitary adenomas include changes in vision, lethargy, headache, nausea, vomiting, change in sense of smell and nasal discharge of clear fluid. The other and more serious symptoms include gigantism, crushing syndrome, reduced sexual function in men, hyperthyroidism and nipple discharge.

Diagnosis

Diagnosis includes blood and urine tests to determine the hormonal levels. Imaging studies such as CT scan and MRI of the brain to determine the size and location of the tumor.

Treatment

Surgery is first option for treating pituitary adenomas. If surgery cannot be done then radiation therapy is given to shrink the tumor. In many cases, medications are also given to shrink the tumor. If the tumor is small in size and is not causing any problems then it is not disturbed and is just regularly monitored through tests.

1. Chahal HS, Stals K, Unterlander M, et al. AIP mutation in pituitary adenomas in the 18th century and today.N Engl J Med. Jan 6 2011;364(1):43-50
2. Parhar PK, Duckworth T, Shah P, et al. Decreasing Temporal Lobe Dose with Five-Field Intensity-modulated Radiotherapy for Treatment of Pituitary Macroadenomas. Int J Radiat Oncol Biol Phys. Dec 14 2009;
3. Sattler MG, Vroomen PC, Sluiter WJ, Schers HJ, van den Berg G. Incidence, causative mechanisms, and anatomic localization of stroke in pituitary adenoma patients treated with postoperative radiation therapy versus surgery alone. Int J Radiat Oncol Biol Phys. 2013; 87(1):53-9 
4. Ramírez C, Hernández-Ramirez LC, Espinosa-de-los-Monteros AL. Ectopic acromegaly due to a GH-secreting pituitary adenoma in the sphenoid sinus: a case report and review of the literature. BMC Res Notes. 2013; 6:411 
5. Berkmann S, Fandino J, Zosso S, et al. Intraoperative magnetic resonance imaging and early prognosis for vision after transsphenoidal surgery for sellar lesions. J Neurosurg. Sep 2011; 115(3):518-27.
6. Greenman Y, Stern N. How should a nonfunctioning pituitary macroadenoma be monitored after debulking surgery? Clin Endocrinol (Oxf). Jun 2009; 70(6):829-32.
7. Han S, Ding X, Tie X, Liu Y, Xia J, and Yan A, et al. Endoscopic endonasal trans-sphenoidal approach for pituitary adenomas: Is one nostril enough? Acta Neurochir (Wien). Jun 5 2013
8. Sankhla SK, Jayashankar N, Khan GM. Surgical management of selected pituitary macroadenomas using extended endoscopic endonasal transsphenoidal approach: early experience. Neurol India. Mar-Apr 2013; 61(2):122-30.
9. Elhateer H, Muanza T, Roberge D, et al. Fractionated stereotactic radiotherapy in the treatment of pituitary macroadenomas. Curr Oncol. Dec 2008;15(6):286-92
10. Marek J, Jezkova J, Hana V, et al. Is it possible to avoid hypopituitarism after irradiation of pituitary adenomas by the Leksell gamma knife? Eur J Endocrinol. Feb 2011; 164(2):169-78.