Headache associated with pituitary tumors

Abstract

The objective of this study is to analyze the presence of headache in pituitary tumors and their characteristics, the relationship between pituitary tumor size, biological type, local extension and intrasellar pressure (ISP). This is a prospective study, of 64 consecutive patients presenting with primary pituitary masses at Neuroendocrinological Department of General Hospital of Fortaleza from October 2005 to December 2006. We analyzed sex, age, headache (laterality, site, severity, quality, frequency, duration, associated symptoms, time of onset, trigger, alleviating factors and familial history) and tumor characteristics (type, size, quiasmatic compression, cavernous sinus invasion, sella turcica destruction, cystic or solid mass and ISP). We observed a statistic significant factor between pituitary tumor and tumor size, optic compression, sellar destruction, cavernous sinus invasion and ISP. Biochemical-neuroendocrine factors, mainly in prolactinomas, seem to be an important factor in the determination of headache. The presence of headache in pituitary tumor is related to a combination of factors, including ISP, tumor extension, relationship with the sellar structures, patient predisposition, familial history, and functional disturbance within the hypothalamo-pituitary axis.

Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement

“…It is reasonable to suppose that the change of tumor size caused by the intratumoral hemorrhage would induce dural stretch around small pituitary adenomas, resulting in severe and chronic headache. Indeed, it has been reported that the ISP of the macroadenoma confined into the sella, without destruction of the floor and with integrity of the diaphragm sellae, is higher than that of tumors with extrasellar extension [8,20]. In our series, usual endoscopic TSS for the pituitary adenomas were performed as final treatment, and the symptoms of all patients were remarkably relieved as shown by the scores of postoperative HIT-6.…”

“…Gondim et al studied the statistical associations between presence of headache and tumor size, optic compression, sellar destruction and cavernous sinus invasion, concluding an association between tumor extension and symptom severity [3,12]. However, in that study, the majority of the patients (81.2%) had macroadenoma and a large mean tumor size of 24.6 ± 15.1mm [8]. These results are inconsistent with the present study where the adenomas were relatively small (15.8 ± 2.6 mm).…”

“…Headache from brain tumor is generally related to traction and displacement of intracranial pain-sensitive structures such as blood vessels, cranial nerves, and dura mater [1,8]. Inflammation involving pain-sensitive structures, meningeal irritation, meningeal involvement in spreading tumor, psychological causes, and biochemical causes have all been described as factors associated with the development of headache [6].…”

“…Therefore, invasion of the cavernous sinus might be expected to cause headache [1,8]. However, Levy and Abe emphasized that large size of the pituitary tumors and cavernous sinus invasion are not essential in the development of headaches associated with pituitary adenomas [2,4].…”

“…The factors contributing to the induction of headache in patients with pituitary adenoma are likely as follows; 1) compression or stretch of vessels and dural structures at the base of the brain, 2) increased sellar pressure, and 3) hormonal hypersecretion [1,3,8]. Among these factors, we focused on compression or stretch of the diaphragm sellae and the medial wall of cavernous sinus, the presence of cyst or hematoma in the adenoma, and ossification in the sphenoid sinus.…”