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Somatotrophic Pituitary Adenoma

Pituitary Adenoma Growth Hormone


Presentation

  • In this paper, we describe a patient who presented initially with a pure PRL secreting pituitary adenoma, and who secondarily developed co-secretion of GH with time.[frontiersin.org]
  • […] majority macroadenomas at presentation.[emedicine.medscape.com]
  • We present a case of synchronous occurrence of a prolactinoma and somatotropinoma. Case presentation A woman presented to an outside clinic at the age of 29 because of menstrual irregularities.[edmcasereports.com]
  • Rarely presentation can be catastrophic, due to pituitary apoplexy. Hormone imbalance Over half of all adenomas are secretory 2, although even when this is the case this may not be the cause of presentation.[radiopaedia.org]
  • We have presented a case of pituitary oncocytoma presenting as microadenoma and Cushing's disease, which was contrary to generally held belief about oncocytoma in literature.[ijem.in]
Swelling
  • Also during this time he experienced fatigue, muscle weakness, thinning of the skin, redness and swelling of the face, and difficulty sleeping. More recently, the patient came to clinical attention because of pain in both feet.[uscapknowledgehub.org]
  • Papilledema, swelling of the optic nerve head caused by increased intracranial pressure, is also late in developing or absent in infants with expansion of the intracranial contents for the same reasons.[dartmouth.edu]
  • This can also be associated with some swelling of the optic chiasm. Hypothalamus Further cephalad lies the base of the brain, which at this location is the hypothalamus.[radiologyassistant.nl]
  • Pituitary apoplexy is a condition that occurs when pituitary adenomas suddenly hemorrhage internally, causing a rapid increase in size or when the tumor outgrows its blood supply which causes tissue necrosis and subsequent swelling of the dead tissue.[en.wikipedia.org]
Surgical Procedure
  • Treatment depends on the type of pituitary tumor: ACTH-producing tumor — Most people with this type of pituitary tumor undergo a surgical procedure called transsphenoidal hypophysectomy.[drugs.com]
  • Transnasal-transphenoidal surgery is an effective and safe surgical procedure for pituitary collision lesions.[hoajonline.com]
  • Criteria for Cure Patients who remain asymptomatic, have a normal serum prolactin level, and, more important, have negative MRI studies for a period of at least 5 years, may be considered to have been cured by the surgical procedure.[pituitaryadenomas.com]
  • However, in this location they are not curable due to the fact that large surgical procedures in the pons usually produce intolerable deficits.[dartmouth.edu]
Italian
  • Google Scholar Copyright information Italian Society of Endocrinology (SIE) 1993 Authors and Affiliations S. Cannavò 1 L. Curtò 1 R. Fazio 1 S. Paterniti 2 A. Blandino 3 T. Marafioti 4 F. Trimarchi 1 1.[link.springer.com]
Hodgkin Lymphoma
  • lymphoma and Non-Hodgkin lymphoma Muscle Tissue Benign Tumors Malignant Tumors Smooth muscle Leiomyoma Leiomyosarcoma Striated muscle Rhabdomyoma Rhabdomyosarcoma Epithelial Tissues Tissue Benign Tumors Malignant Tumors Stratified squamous Papilloma[training.seer.cancer.gov]
Visual Impairment
  • The pattern of visual impairment in patients with pituitary adenoma. J Int Med Res. 2008; 36 (5): 1064-9[ PubMed ] 12. Dekkers OM, Hammer S, de Keizer RJ, Roelfsema F, Schutte PJ, Smit JW, et al.[ijcancerprevention.com]
  • RCCs are commonly asymptomatic, but may present with headaches, visual impairment, and hypopituitarism, among other symptoms [ 18 ].[hoajonline.com]
Osteoporosis
  • Prolonged effects of excessive GH secretion include: arthritis carpal tunnel syndrome osteoporosis kyphosis hypertension arteriosclerosis heart enlargement heart failure Acromegaly develops slowly.[healthguidance.org]
  • Growth retardation in children; osteoporosis in adults Capillary fragility, ecchymoses, poor wound healing, easy bruisability. (in part, due to altered collagen synthesis).[cushings-help.com]
  • Osteoporosis and its sequelae are rare presenting clinical features in patients with prolactinomas.[pituitaryadenomas.com]
  • The excess cortisol causes the classic features of Cushing’s syndrome including, but not limited to: acne, facial hair, weakness, osteoporosis, cataracts, diabetes mellitus, increased risk of infections, and easy bruising.[virtualmedstudent.com]
  • Because of the risk of osteoporosis carried by long term amenorrhea, the patient then agreed upon taking dopamine agonist therapy and was started on oral Cabergoline (Dostinex 0.5 mg/week) in June 2002.[frontiersin.org]
Arthralgia
  • On specific questioning, she also reported disseminated arthralgias, and symptoms suggestive of carpal tunnel syndrome.[frontiersin.org]
Claustrophobia
  • The patient refused to undergo a pituitary MRI because of claustrophobia, and a head CT scan disclosed the presence of a microadenoma (7 4 mm) in the left lobe of the pituitary gland.[frontiersin.org]
Secondary Amenorrhea
  • She did not breast feed her baby, and was seen again in May 1997, where she complained of persistent secondary amenorrhea and intermittent galactorrhea of 10 months’ duration.[frontiersin.org]
  • Furthermore, hyperprolactinemia in females may suppress and/or interfere with the menstrual cycle and result in primary or secondary amenorrhea and infertility.[pituitaryadenomas.com]

Workup

  • A careful study of hormonal workup and pre-operative imaging is necessary for synchronous pituitary adenomas to assure resection of both tumors. Summary Pituitary adenomas are usually solitary lesions.[edmcasereports.com]
  • […] adenomas show numerous enlarged mitochondria with loss of cristae and presence of electron dense tubular structures ( Brain Pathol 2012;22:443 ) Molecular / cytogenetics description No specific molecular characteristics in routine clinical diagnostic workup[pathologyoutlines.com]
  • While a majority of patients with endogenous Cushing syndrome have thyrotrophic adenomas (called Cushing Disease - see below), other tumors should also be considered as part of the endocrinologic workup, including adrenal tumors and especially ACTH-secreting[eyewiki.aao.org]
  • The lab workup of acromegaly is straightforward. Your screening test is a spot blood insulin-like growth factor I (IGF-I). If this is normal, acromegaly is unlikely.[pathguy.com]
  • Although ultrastructural examination still has an important role in the workup of unusual pituitary adenomas, ultrastructural examination was the only reliable way to subtype and determine the cellular origin of pituitary adenomas in the past.[nature.com]
Enlarged Sella
  • ., bitemporal hemianopsia; "Big Robbins" contains an error here) or optic nerves (blindness in one eye); (3) enlarged sella turcica on skull x-rays, again due to expanding masses; (4) least often, signs of increased intracranial pressure (i.e., headache[pathguy.com]
Hyperprolactinemia
  • Hyperprolactinemia may occur in association with a variety of pituitary adenomas.[pituitaryadenomas.com]
  • Signs and symptoms of hyperprolactinemia are not always apparent. Morphologically, the tumors are similar to GH-secreting adenomas, with an eosinophilic or chromophobic appearance.[emedicine.medscape.com]
  • Significant hormonal excess in 29% of cases included hyperthyroidism in 17%, acromegaly in 8% and hyperprolactinemia above 150 μ g/l in 4%.[nature.com]
  • It is the reason why masses other than adenomas can cause hyperprolactinemia. This is also why an unenhanced MRI scan suffices in a patient with hyperprolactinemia: it is not the size of the microadenoma, but ruling out other pathology that matters.[radiologyassistant.nl]
  • SILENT SUBTYPE 3 INCIDENCE-3% C/F Mass effects; hyperprolactinemia or GH effects  BLOOD -No specific hormone GROSS:Usually macro MICROSCOPY: C to mild A and show some degree of nuclear pleomorphism and nucleolar prominence.[slideshare.net]
Prolactin Increased
  • In summary, patients with microadenomas are more likely to have preoperative prolactin levels 200 ng/ml, and the cure rate in this group falls progressively as the levels of prolactin increase.[pituitaryadenomas.com]
Lymphocytic Infiltrate
  • Pituitary macroadenoma with persisting dense lymphocytic infiltration in a young male patient. Clin Neuropathol. 2011; 30 (6): 318-23[ PubMed ][ijcancerprevention.com]
  • Microscopic Features: [31] Lymphocytic infiltration. Lymphocytic hypophysitis, CD3 IHC. (WC/jensflorian) CNS cytopathology. Neuropathology. Brain tumours. 2.0 2.1 3.0 3.1 URL: .[librepathology.org]

Treatment

  • In May 2004, recurrence of amenorrhea under treatment motivated a repeat head CT scan which disclosed a small decrease in size of the adenoma.[frontiersin.org]
  • Succesful treatment of acromegaly: metabolic and clinical studies in 145 patients. J. Clin. Endocrinol. Metab. 31 : 180, 1970. PubMed CrossRef Google Scholar 15. Probst A.[link.springer.com]
  • Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments.[cancer.net]
  • Treatment for Hyperpituitarism Treatment can consist of pituitary microsurgery to remove tumor.[healthguidance.org]

Prognosis

  • Prognosis Recurrent symptoms requiring further intervention is relatively common, with 18% of patients with non-functioning tumors and 25% of patients with prolactinomas eventually needing further treatment 6 .[radiopaedia.org]
  • The prognosis is highly variable: cerebellar astrocytoma has a good prognosis, pontine glioma has a bad prognosis because of location.[dartmouth.edu]
  • People with small tumors that do not need immediate treatment or can be completely removed with surgery have an excellent prognosis. Even for large tumors that interfere with vision, surgery can stop further deterioration of vision.[drugs.com]
  • Prognosis Remission can be obtained in up to 90% of patients with microadenomas and in about 50% to 60% of those with macroadenomas. [ 1 ][patient.info]
  • In 1979 Symon etal.[16] introduced the term giant for pituitary adenomas larger than 4 cm in any direction.[2,12] Histologically, micro- and macro adenomas are identical.[14,15] Not surprisingly, however, larger lesions have a worse prognosis than smaller[barrowneuro.org]

Etiology

  • Thus, a multifactorial etiology may be responsible for its origin.[neurologyindia.com]
  • Overall, pituitary adenomas have a highly variable etiology that differs from person to person.[virtualmedstudent.com]
  • […] of somatotrophs, lactotrophs and thyrotrophs SF-1 (steroidogenic factor 1): gonadotroph cell differentiation T-PIT (T-box family member TBX19): proopiomelanocortin (POMC) lineage with differentiation of corticotrophs ( Acta Neuropathol 2017;134:521 ) Etiology[pathologyoutlines.com]
  • Histiocytosis X is a non-neoplastic disorder of unknown etiology characterized by masses of proliferating histiocytes, plasma cells, and eosinophilic inflammatory cells forming granulomas within any organ system in the body [ 4 ].[em-consulte.com]
  • Most symptoms stem from hypersecretory etiologies, the manifestations of which depend on the hormone secreted, while other hormonal symptoms may be attributed to varying degrees of pituitary insufficiency.[hoajonline.com]

Epidemiology

  • Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. 2004; 25 (1): 102-52[ DOI ][ PubMed ] 14. Otsuka F, Ogura T, Yamauchi T, Shikata K, Kageyama J, Makino H.[ijcancerprevention.com]
  • Epidemiology [ 1 ] Pituitary tumours account for 10% to 25% of all intracranial neoplasms. Adenomas account for the largest portion of pituitary neoplasms (estimated at approximately 17%). Only a minority of adenomas are symptomatic.[patient.info]
  • Although it is now well recognized that hyperprolactinemiainduced hypogonadism has a deleterious effect on the skeleton in both sexes, the epidemiologic and overall clinical significance of this effect is not known.[pituitaryadenomas.com]
  • Cree Modern Pathology (2018) Epidemiology and biomarker profile of pituitary adenohypophysial tumors Ozgur Mete, Amber Cintosun, Irwin Pressman & Sylvia L.[nature.com]
  • […] less commonly patients may also have Ocular motility deficits and/or Diplopia, certain forms of Nystagmus, signs and symptoms of Increased intracranial pressure due to mass effect, Optic atrophy, or sequelae of Pituitary apoplexy. [3] [4] [5] General Epidemiology[eyewiki.aao.org]
Sex distribution
Age distribution

Pathophysiology

  • However, in contrast to the patient described here, the primary tumor in their report was an aggressive prolactinoma, suggesting a different pathophysiological mechanism from the start.[frontiersin.org]
  • […] pituitary gland C75.1 Sites Majority occur in sella turcica within the adenohypophysis / anterior pituitary lobe Rare examples occur in extrasellar region on pituitary stalk Rare prolactinomas as part of ovarian teratoma ( Endocr Pathol 2014;25:321 ) Pathophysiology[pathologyoutlines.com]
  • The exact pathophysiology of this phenomenon is unknown; however, as most of these lesions involve the chiasm and/or diencephalon, many have proposed that disruption of visual and vestibular input contribute to this pathology.[eyewiki.aao.org]
  • These changes represent the clinical application of an enhanced understanding of the pathophysiology of prolactin secretion and its systemic effects, advances made in neuroendocrinology, and a heightened recognition of the pathologic changes associated[pituitaryadenomas.com]

Prevention

  • , IR Iran 2 Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran 3 Department of Radiation Oncology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Article information Iranian Journal of Cancer Prevention[ijcancerprevention.com]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.de]
  • Prevention Because doctors do not know why pituitary tumors develop, there is no way to prevent them.[drugs.com]

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