Pituitary adenoma

Pituitary adenoma – a benign neoplasm of the brain. The tumor grows in the epididymis, which is the size of a small pea – the pituitary gland. This gland is one of the central organs in the endocrine system. The pituitary gland affects human growth and development, metabolism and hormone production by other endocrine organs. Without timely treatment, a pituitary adenoma can lead to partial or complete loss of vision, as well as to hormonal disorders.

Contacting the MedTour coordinator will allow you to learn about modern diagnostic and treatment methods in foreign clinics. With timely and high-quality medical care, patients are completely cured of a pituitary adenoma.

The causes of pituitary adenoma

Scientists believe that pituitary adenoma occurs spontaneously. Genetic mutations play a key role in the development of adenoma. The structure of genes changes during life under the influence of various environmental factors.

Genetic mechanisms govern the growth, division and development of every cell in the human body. A mutation in the DNA that stores information about a person can lead to uncontrolled growth of the adenohypophysis.

Certain hereditary syndromes and diseases increase a patient’s chances of having a pituitary adenoma. These conditions are referred to as risk factors for the development of the disease:

• Multiple endocrine neoplasia type 1. Hereditary disease causes the development of benign and malignant tumors in various endocrine structures, including the pituitary gland;

• Carney complex (LAMB or NAME syndrome). Also refers to a hereditary disease. Patients have benign tumors of the heart and skin (myxomas), skin hyperpigmentation and increased activity of the endocrine system;

• Familial isolated pituitary adenomas (FIPA). This disease is characterized by a history of pituitary adenoma in two or more relatives. At the same time, other endocrine organs are not affected.

Pituitary adenoma can occur at any age. Until the age of 20, the risk of adenoma is slightly lower than at an older age.

Types of pituitary adenomas

In order to prescribe the correct treatment and determine the prognosis of the disease, doctors divide adenomas by size and ability to produce hormones. Depending on the size of the tumor, there are:

• Up to 10 mm – microadenomas;
• More than 10 mm – macroadenomas.

In half of the cases, identified adenomas produce excess hormones. Such adenomas are called hormone-active. Doctors isolate hormone-active adenomas with increased production of the following hormones:

• Prolactin;
• Adrenocorticotropic hormone;
• Somatotropin (growth hormone);
• Thyroid-stimulating hormone.

Symptoms of a pituitary adenoma

Signs of a pituitary adenoma are diverse and differ in each individual case. This is due to the peculiarity of the tumor. If an adenoma produces an excess amount of a certain hormone, doctors will identify it in the early stages based on characteristic endocrinological symptoms.

Hormone-inactive tumors can grow to the size of a macroadenoma (more than 1 cm), since they don’t cause any symptoms for a long time and don’t bother the patient. Often they are detected by chance during CT or MRI for other diseases.

Diagnostics of the pituitary adenoma

Consultation and examination by a doctor

The doctor will take a medical history and review your medical history. If you suspect a pituitary adenoma, it is important to exclude hereditary forms of diseases, for example, multiple endocrine neoplasia. Therefore, the doctor may ask questions about the health of your relatives.

After that, the doctor examines the patient to exclude obvious endocrinological disorders. During the period of diagnosis, the patient can consult a neurosurgeon, ophthalmologist, endocrinologist, radiation therapist and other specialists.

Vision research

Increasing in size, the pituitary adenoma extends beyond its anatomical zone – the sella turcica and squeezes the surrounding structures, including the optic nerves. This leads to visual impairment. Initially, the patient may have impaired lateral (peripheral) vision. With the growth of the tumor, visual acuity drops to complete blindness. An ophthalmologist will conduct special tests and examine the fundus to assess the extent of damage to the optic nerves.

Laboratory tests

To accurately determine if the adenoma is producing any hormones, the doctor will order laboratory blood and urine tests. The following indicators are measured:

• Plasma prolactin (PRL);
• Growth hormone (somatotropin);
• Insulin-like growth factor-1 (IGF-1);
• Free thyroxine;
• Free testosterone;
• Free cortisol.

An increased level of one of the hormones indicates obvious endocrinological disorders, however, laboratory tests don’t directly indicate the presence or absence of a pituitary adenoma.

Radiological examination

CT (Computed tomography)

Computed tomography allows you to see large pituitary adenomas. Doctors obtain images using x-rays. The resulting images are processed by a computer and the resulting images are more detailed than conventional radiography.

MRI (Magnetic resonance imaging)

MRI is the “gold standard” for diagnosing pituitary adenoma. Unlike CT, magnetic resonance imaging examines the electromagnetic radiation of tissues. These shots are more detailed and accurate. MRI can detect adenomas less than 3 mm in diameter (microadenomas).

Examples of the cost of pituitary adenoma diagnostics in clinics around the world:

• Ukraine – from $850;
• Turkey – from $1 500;
• Germany – from $2 700;
• Israel – from $3 500.

A pituitary adenoma in a foreign clinic is diagnosed within 1-2 days. Treatment can be arranged in 2-3 days. The coordinating doctor of MedTour will help you determine the clinic and make an appointment with the doctor.

How long do you live with a pituitary adenoma

Adenoma of the pituitary gland does not affect adjacent tissues and does not give metastases. Usually, pituitary tumors have a favorable prognosis and don’t lead to death. The five-year survival rate since diagnosis is over 97%.

Despite this, pituitary adenoma is a dangerous disease that threatens the health and life of the patient:

• Intensive tumor growth causes compression of the surrounding brain tissue. Increased intracranial pressure and compression of nerve cells leads to dysfunction of the central nervous system;
• Adenoma affects the anterior part of the pituitary gland – the adenohypophysis, which is responsible for the production of hormones. This can lead to overproduction of a number of hormones, which inevitably affects the patient’s health.

Tumors of the pituitary gland are common – up to 15% of all intracranial tumors. According to Johns Hopkins University (USA), pituitary adenoma can develop in 1 in 10 people during their lifetime.

In most cases, the adenoma is asymptomatic and does not bother the person. In 50% of patients, pituitary tumors lead to changes in the secretion of hormones.

Treatment of pituitary adenoma

Not all pituitary tumors require treatment. In some cases, active monitoring is sufficient – regular visits to a neurosurgeon or endocrinologist and performing radiological studies. This allows doctors to monitor the adenoma over time. Doctors begin active treatment if the adenoma continues to grow or endocrinological symptoms worsen.

In modern medical centers for the treatment of pituitary adenoma, surgery, radiation therapy or drug treatment are performed. These methods are used both separately, as monotherapy, and as a combination treatment.

Surgical treatment of pituitary adenoma

Surgery is necessary if the adenoma compresses the optic nerves or other structures of the brain, and also produces an excess amount of any hormone.

In foreign clinics, doctors prefer minimally invasive removal of brain tumors. A pituitary adenoma can be removed through the nasal passage and sinuses. This operation is called endoscopic transnasal transsphenoidal adenomectomy. The main advantage is the absence of incisions in the head area.

Large pituitary tumors are removed through a small incision in the skull. This type of surgery is called a craniotomy. This technique allows you to get to more difficult and larger adenomas.

Examples of the cost of endoscopic removal of a pituitary adenoma in clinics in different countries:

• Israel – from $30 000;
• Germany – from $25 000;
• Turkey – from $16 000;
• Ukraine – from $12 000.

Radiation therapy for pituitary adenoma

A radiation therapist uses targeted high-energy power sources for non-surgical removal of tumors, including pituitary adenomas. Radiation therapy is performed as an independent method of treatment or in combination with surgical removal. For treatment, special devices are used – linear accelerators and radiosurgical units.

Leading foreign medical centers offer patients various options for radiation therapy.

Stereotactic radiosurgery

The adenoma is irradiated with a concentrated beam of energy during one session. Before the procedure, the effective dose is calculated and the exact location of the tumor is calculated using MRI and CT. During the procedure, healthy tissues and organs are not damaged.

External beam therapy

Unlike radiosurgery, radiation is divided into several sessions. The entire treatment cycle can last for 4-6 weeks. This technique is effective for large tumors, when it is impossible to achieve an acceptable result in 1 procedure.

Intensity modulated radiation therapy

The main feature of this technique is the computer calculation of the dose and radiation intensity. New linear accelerators are able to distribute radiation at different angles and in different parts of the tumor. This method makes it possible to most effectively affect the tumor with minimal impact on healthy tissue.

Proton therapy

The most modern method of radiation therapy. Radiation is not based on X-rays, but on protons. Proton particles have the advantage – when interacting with tissues, they stop and don’t spread to surrounding tissues, as does X-ray radiation.

Foreign clinics have modern equipment for effective and safe radiation therapy. Varian Truebeam stx linear accelerators, CyberKnife radiosurgical units and O-ARM CT scanners are used for neuronavigation during surgery.

The choice of the method of radiation therapy is influenced by the size of the tumor, the presence of concomitant diseases, the age of the patient, and other factors.

Examples of the cost of radiation therapy for pituitary adenoma in clinics in different countries:

• Israel – from $25 000;
• Germany – from $18 000;
• Turkey – from $10 000;
• Ukraine – from $5 500.

Drug treatment

An endocrinologist may prescribe special medications to block the action of excess pituitary hormones or to shrink the tumor.

Most drugs reduce the activity of prolactin, adrenocorticotropic hormone, and growth hormone (somatotropin).

Before prescribing drug therapy, the patient undergoes a thorough examination of the level of hormones, since drugs can cause side effects.

After removal of the tumor or radiation therapy, the normal levels of pituitary hormones may decrease. In this situation, the doctor prescribes replacement therapy to keep the hormone levels normal.

Benefits of pituitary adenoma treatment in a foreign clinic

• A patient with pituitary adenoma is treated by an interdisciplinary team of doctors: neurosurgeons, therapists, endocrinologists, ophthalmologists, functional diagnosticians. This avoids medical error and proposes the most effective treatment plan.
• Neurosurgical operations in foreign hospitals are performed using a minimally invasive method. A pituitary adenoma can be removed through the nasal passage, without skin incisions and traumatization of the skull bones. The operation is performed using neuronavigation systems.
• The therapy plan is developed in accordance with european and american treatment protocols. The protocols are based on years of research, which have been shown to be effective in practice.
• Patients have access to modern treatment methods and the opportunity to participate in clinical trials. This allows the treatment of severe cases of pituitary adenoma, even if the clinic at the place of residence cannot offer effective therapy.
• Large medical centers are equipped with their own laboratory, pharmacy and new diagnostic equipment. The patient undergoes diagnostics in one building without long waiting times and queues.
• In foreign clinics, non-surgical methods of treating pituitary adenoma using radiosurgery are available. Medical centers are equipped with radiosurgical units – X-Knife, CyberKnife and Clinac.

How much does pituitary adenoma treatment cost?

The cost of treatment is calculated on a case-by-case basis. The price is influenced by the country in which the patient was treated, the accreditation of the clinic, and the qualification level of the doctor. Depending on the type of adenoma, the doctor prescribes one method of treatment or complex therapy. The treatment plan is formed after a comprehensive diagnosis.

If a patient is planning his treatment in a foreign clinic, it is important to take into account the additional costs associated with air travel and accommodation. Leave a request on the MedTour platform so that our medical coordinator will select the best options for you.

Frequently Asked Questions

1

Compression symptoms

Over time, the adenoma begins to press on the surrounding structures of the brain and increases intracranial pressure. This leads to the development of general symptoms:

• Nausea and vomiting;
• Dizziness;
• Headaches;
• Double vision;
• Decreased peripheral vision;
• Loss of consciousness;
• Numbness of the face;
• Sudden blindness.

Vision problems are associated with the pressure of the tumor on the optic tract, which connects the eye and the center of vision in the brain. Visual impairment can be reversible if the tumor is diagnosed on time and treated quickly.

1

Symptoms of hormonal deficiency

Adenoma can compress normal cells of the pituitary gland, which leads to disruption of normal hormone secretion. Lack of pituitary hormones affects the general condition of the patient and leads to the development of the following symptoms:

• General weakness and feeling unwell;
• Feeling cold;
• Hair loss all over the body;
• Breast augmentation in men (gynecomastia);
• Decreased libido;
• Unreasonable increase or decrease in body weight;
• Nausea.

1

Symptoms of increased hormone production

A growth hormone

Adenoma can produce large amounts of growth hormone – somatotropin. If the tumor develops in childhood and adolescence, growth hormone causes gigantism. Patients with gigantism are abnormally tall. Usually, children complain of excessive sweating and bone pain.

In adults, further body growth is impossible, since long tubular bones don’t respond to growth hormone. Under the influence of an excessive amount of growth hormone, the growth of the bones of the skull, face, arms and legs is observed in patients. This condition is called acromegaly.

Adrenocorticotropic hormone (ACTH)

If the pituitary gland overproduces ACTH, the patient develops Cushing’s disease. In this pathological condition, the adrenal glands produce too much cortisol. Normally, cortisol is very important for the body, as it is involved in the metabolism of carbohydrates in the body and is responsible for the stress response.

Symptoms are characteristic of Cushing’s disease:

• Puffiness and redness of the face area;
• A sudden increase in body weight;
• Headaches;
• Increased hair growth on the chest, abdomen and face;
• Deterioration of vision;
• High blood pressure;
• Purple stretch marks on the abdomen and thighs;
• Easy bruising with minor injuries;
• Decreased libido;
• Violation of the menstrual cycle in women;
• Decreased mood background up to depression.

Prolactin

An adenoma that produces an excessive amount of prolactin is called prolactinoma or lactotrophic adenoma. Doctors more often find this tumor in young girls and elderly men. Prolactin is important for the regulation of female sex hormones, sexual arousal. The hormone regulates milk production in the breast in postpartum women.

Prolactinoma affects women and men in different ways. High prolactin levels in men lead to breast enlargement and erectile dysfunction. In women, the menstrual cycle is disturbed. Common symptoms are decreased libido and infertility.

Thyroid-stimulating hormone

Adenoma of the pituitary gland with increased secretion of thyrotropin is quite rare. Thyroid stimulating hormone affects the thyroid gland, which in turn secretes many hormones T3 (triiodothyronine) and T4 (thyroxine).

Symptoms of an overactive thyroid gland:

• Weight loss;
• Hand tremor;
• Feeling of heat and intolerance to high ambient temperatures;
• Excessive sweating;
• Swelling of the front of the neck in the projection of the thyroid gland;
• Anxiety, accelerated pace of thinking;
• Sleep disturbance.

Gonadotropic hormone

Gonadotropic adenomas produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This can lead to decreased libido and infertility in both women and men.

Adenomas secreting gonadotropic hormones are usually asymptomatic. The hormones produced are usually not enough to cause the above symptoms. Asymptomatic tumor growth leads to the development of a macroadenoma, which compresses the surrounding nerve tissue.

Published: 07.07.2021

Updated: 29.07.2021

Medical expert:

PhD. Olexandr Voznyak

Medical author:

Ilona Baidiuk

Information on this webpage verified by the medical expert

Medical Doctor, oncologist, PHD student

Kateryna Maliarchuk