Pituitary tumors: pathophysiology, clinical manifestations and management.

Abstract

Pituitary tumors are frequently encountered intracranial neoplasms. They present with a variety of clinical manifestations that include symptoms and signs of excessive hormone secretion by the tumor, signs of hormone deficits by the normal pituitary gland and others related to expansion of the tumor mass and the resulting compression of surrounding structures such as the optic chiasm and cranial nerves. Advances in molecular biology, immunocytochemical staining and imaging, and the introduction of new treatment options have improved our understanding of the natural history of these adenomas and their management. Available treatments include surgical, medical and radiation therapy. Although the primary treatment for each tumor type may vary, it is important to consider all available options and select the most applicable for that patient. The interaction of all members of management team, including the primary care provider, the endocrinologist and the neurosurgeon in selecting the treatment course can only improve therapeutic outcome. Regardless of the initial choice of treatment, follow-up of all patients should be maintained indefinitely. The managing physician should be familiar with the natural history and long-term complications of pituitary adenomas, and with the side effects of treatments given over the years.

Magnitude, Clinical Presentation and Outcome of Patients with Pituitary Lesions:An Experience from Tikur Anbessa Specialized Hospital, Ethiopia

“…Prolactinomas were the most common type of pituitary lesions similar to studies done in other countries followed by Cushing's disease and Acromegaly [3,5,20]. ACTH-dependent Cushing syndrome accounted for 21.43% of all patients with pituitary lesions which is a higher proportion when compared to other studies.…”

“…Although pituitary tumors are said to account for 10 to 15% of all intracranial neoplasms, their true incidence has not been established with certainty [1][2][3][4]. In our study pituitary lesions accounted for 4.54% of patients who visited endocrine clinics of TASH.…”

“…In one study of acromegalic patients there was no significant difference of proportion of men and women and 74.7% had a macro adenoma with a mean tumor diameter of 1.86 cm (0.2-4.6) [13]. Corticotroph adenomas represent approximately 10-12% of all pituitary adenomas and are seen predominantly in women, with a female to male ratio of 8:1 and with a peak incidence in the third to fourth decades of life [3].…”

“…The prevalence of these tumors in autopsy series is reported to be 5-20%, with most series estimating the prevalence to be approximately 10% [3]. Another meta-analysis found an overall estimated prevalence of pituitary adenomas of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies) [4].…”

Pregnancy and pituitary disorders

“…Prolactinomas are the most common cause of persistent hyperprolactinemia and account for 50% of the functioning pituitary tumors (134). After the use of bromocriptine as the first-line treatment in prolactinomas since the 1970s, pregnancies in patients lacking a previous history of surgery and growth of prolactinoma during gestation have been described.…”