1. With pituitary adenomas
The pituitary adenoma, is a type of brain tumor that can be in the pituitary gland. Pituitary gland is a thing of about pea-sized, which is in the recess of sella turcica in the bottom-center of the skull. Above the pituitary gland, we are crossing the optic nerve is necessary in order to see things is gradually extending to the left and right eye. In addition, next to the pituitary gland, nerves that move the eyeball and (internal carotid artery) important blood vessels that send blood to the brain has been through. Pituitary gland is divided into two parts of the small posterior lobe and the anterior lobe, which account for the most part, I am secretes many hormones as the center of hormones throughout the body. Important thing is the next five in a hormone secreted from the anterior lobe.
Important thing is the next five in a hormone secreted from the anterior lobe.
1. Growth hormone
Through puberty from childhood, I encourage the growth of internal organs and limbs.
2. Prolactin
I will serve to secrete milk after delivery. menstruation has ceased while this hormone is secreted large amounts.
3. Thyroid stimulating hormone
And it works to secrete thyroid hormone by the thyroid gland to instruction. You need a lifetime for both men and women.
4. Adrenocorticotropic hormone
And it works to secrete adrenocorticotropic hormone with instructions to the adrenal glands. You need a lifetime for both men and women.
5. Gonadotropin
There are two types of luteinizing hormone and follicle-stimulating hormone. Dominates the ovaries in women and testes in men and promotes the secretion of sex hormones, respectively. In addition, it is also important hormone for normal development of sperm or eggs.
Hormone from the posterior lobe is the following two.
1. Antidiuretic hormone
It serves to reduce the amount of urine and works on the kidneys, you need life for both men and women.
2. Oxytocin
I shrink the uterus at the time of delivery.
Growth rate is slow benign, it spread to other organs other than the brain is very rare pituitary adenoma most. It often occurs in adults 20-50 years of age, accounting for about 15% of the entire brain tumor. The Turkey saddle near the presence of a pituitary gland, another tumor, such as craniopharyngioma can be some, but they are ” brain tumor (adult) “or” brain tumor (children) see the section “of . The pituitary adenoma, and there is a (non-hormone-secreting adenoma) in which the (adenoma of hormone production type), do not secrete hormones that secrete many abnormal hormone. In adenoma of hormone production type, abnormalities of various body will appear depending on the type of hormone produced, but in the case of hormone-secreting adenomas, it may not be found easily for asymptomatic until tumors grow quite large. As with many cancers, the probability of being able to totally cure the treatment used mainly with surgery to be found between pituitary adenoma is small will be higher. Tumor becomes large, when I come to involve such important brain tissue, cranial nerves, brain blood vessels of the peripheral, also be that Kiru taken completely by surgery more difficult, treatment with drugs or radiation therapy is performed after surgery there. In addition, the hormone-producing adenoma type of some sort, there is also that the drug therapy is tried first. Tumor becomes large, the pituitary gland of normal and will come under pressure by the tumor, the hormone necessary for the body to come in short supply even more, replacement therapy of hormone missing is required in this case.
2. Symptom
The symptoms due to pituitary adenoma, due to the fact that the hormone is secreted in excess can be roughly divided into hormone syndrome and, of local due to the tumor increases pressure symptoms you may be. Hormone-producing adenoma type can be classified by the type of hormone produced. I will describe the symptoms for each below.
1) prolactin-producing adenoma
It is a tumor that accounts for about 40% of the pituitary adenoma, found predominantly in women. And lactation amenorrhea is seen in women. In the case of men, impotence and decreased libido can be seen. There is also a view that the failure to appear when it becomes large. More women likely to be detected at an early stage, that of small tumors of less than 1cm are many, and it is one of the causes of female infertility.
2) growth hormone-producing tumor
Accounts for about 20% of adenomas, I seen slightly more men. It becomes gigantism If you develop during puberty, but this is relatively rare. It becomes acromegaly tip of the hands and feet, forehead, chin, lips, and tongue will have hypertrophy develops in adults many. Therefore, the size of the shoes and ring or no longer fit, look or you will have changed within a few years. Abnormal secretion of growth hormone is followed by a long period of time, making it easier to merge the vascular lesions, such as high blood pressure and associated diabetes.
3) adrenocorticotropic hormone-producing adenoma
Is a rare tumor that can not be found only a few percent of all pituitary tumors, many middle-aged women from the young, it is called Cushing’s disease. Obesity was observed in 90% or more, face rounded to the moon in particular, central obesity to breast-belly gain weight compared to the limbs is a characteristic. Acne is easy to appear, body hair is darker, you are Sujigami of blue-violet in the lower abdomen. In addition, there is also complicated by diabetes and high blood pressure at a high rate, psychiatric symptoms may appear.
occur because the tumor is increased pressure symptoms include the following:.
1) pituitary hormone production failure (pan-pituitary dysfunction)
Libido and impotence is reduced irregular menstruation or amenorrhea, in men, hair will also thin in women. In addition, it becomes the lack stamina and tired easily. In addition, you may not be able to recover easily from a state of shock when strong physical shock occurs. Antidiuretic hormone is insufficient, (diabetes insipidus) will occur symptoms leaving a large amount of thin urine.
Failure of
2) visual acuity, field of view
When the tumors will have expanded upward, I will begin to put pressure on the optic nerve cross-section immediately above. First, I’ll be difficult to see from the outside on both eyes. Outside half of both eyes is becoming invisible and further progresses, it becomes the typical symptoms called bitemporal hemianopia.
3) headache
Headache also often observed.
3. Diagnosis
The diagnosis of pituitary adenoma, there is the (hormone test) endocrinological examination and diagnostic imaging, such as by X-ray mainly.
1) diagnostic imaging
(1) MRI
You can even get a free image of the fault plane in a test using a strong magnetic field of magnetic resonance method, it is possible to reflect the only brain tumor or no effect of the skull, and also can be. It is possible the structure of the pituitary gland near the brain and can be observed over the details, to know the exact extent and size of the tumor. Further, since it is possible running of important blood vessels is also depicted, it can be said imaging modalities currently the most useful.
(2) CT
In tomography using a computer and X-ray, it is a diagnostic method most common. It has excellent characteristics such that it can check the status of the bone adenomas around when the combination of the contrast agent, the diagnosis of small adenomas becomes possible also increased.
X-ray examination of (3) head
I examine the bone changes such as deformation and destruction of the sella turcica.
(4) cerebral angiography
Important internal carotid artery to send nutrients to the brain is traveling on both sides immediately pituitary, can get to know preoperatively whether or not there is a malformation or traveling abnormality of this artery is important. This is done by advancing to the blood vessels in the brain narrow tube from the femoral artery.
2) hormone test
The hormone test, there is a meaning and examine the meaning and to examine the hormone that is secreted in excess by adenoma, a hormone in a state in which secretion was decreased in reverse, do the blood collection from vein mainly. In the case of hormone-producing adenoma, blood levels (prolactin, growth hormone, and adrenocorticotropic hormone) of the hormone indicates the abnormally high, I will lead to direct diagnosis. It may make various suppression test and test stimulus, to investigate the secretion kinetics. On the other hand, for a hormone that decreases the secretion, I will do the test stimulus secretion of the hormone. After injection of each formulation stimulating hormone secretion usually examine the changes in the blood levels of the hormone of interest continuously bled 15-30 minutes each.
Inspection of 3) ophthalmology
Make a thorough examination vision, field of view, of the fundus.
Inspection of 4) otolaryngology
If you are planning a nasal surgery described below, you should examine whether there is any problem or inflammation in the paranasal sinus and nasal cavity.
4. Treatment
For the treatment of pituitary adenomas, there is a treatment of three of chemotherapy surgery, and radiation therapy, and combination therapy is determined type and size of each tumor, symptoms, such as by age.
1) Surgery
There are two ways of craniotomy and nasal surgery, and is selected by a variety of conditions such as the size and direction of adenoma development. After surgery, hormone replacement therapy is required in many cases.
(1) nasal surgery
An incision was made the oral mucosa of the base of the upper front tooth, you will reach just below the pituitary gland through the paranasal sinuses on the back of the nasal cavity. An incision was made with a thin film, and a hard bone, to remove a pituitary adenoma while leaving the pituitary gland of normal.
(2) craniotomy
Open the window to the bone through an incision in the skin of the hairline of the forehead, were dissected the dura mater covering the brain and reach the pituitary Lift with a special spatula brain. I removed a tumor from between the normal tissues such as the internal carotid artery and optic nerve located around.
2) radiation therapy
Usually, in combination with surgery, etc., it is used as adjunctive therapy for tumors that remained after surgery. For five consecutive days per week, I will irradiation over a period of approximately 4-5 weeks. It is also possible to be treated while ambulatory. In recent years, a method of irradiating a short period of time-intensive part of the tumor in a narrower range is also becoming possible. There are few side effects, but as if it does not come grow with the case where the hair of the part before the ear is missing, come grow again. After treatment, hormone replacement therapy is required in many cases. It is believed that the effect of radiation lasts for a relatively long period of time, and has worked for several years.
(See: 3) chemotherapy drug therapy of cancer )
It is a treatment to suppress the production of hormones that adenomas secreting abnormally. Some of them show a marked response to chemotherapy for adenoma of hormone production type, but some less effective. As that obtained the most reliable therapeutic effect current (trade name: Paroderu) bromocriptine being used for prolactin-producing adenoma there is. This drug, effect was observed in 1/3 of the growth hormone-producing tumor and most of the prolactin-producing tumors, hormone levels in the blood not only decrease, reducing the effect of the tumor will also be expected to prolactin-producing adenoma in particular. Therefore, if there is residual tumor or at small tumor, bromocriptine therapy have been made without radiotherapy in these tumors. There is no serious side effects to taking bromocriptine, but can be lightheadedness and nausea taking at the start of symptoms such as constipation can be seen.
(See 4) hormone replacement therapy: . 12 hormone therapy drug therapy of cancer )
For essential hormone, replacement therapy is required depending on the degree of deficiency. I supplements in oral medicine thyroid hormone and adrenocorticotropic hormone. There is a medicine that blowing the nose anti-diuretic hormone. Refill for your situation for gonadotropin hormone and growth hormone.
5. Summary of treatment policy in each adenoma
1. Hormone-secreting adenoma
Surgery + “radiation therapy”
2. Prolactin-producing adenoma
Bromocriptine therapy surgery + + “radiation therapy”
3. Growth hormone-producing adenoma
Surgery plus radiation therapy + “bromocriptine therapy”
4. Adrenocorticotropic hormone-producing adenoma
Surgery + “radiation therapy”
5. Recurrent pituitary adenoma
I will attempt (combination therapy also included) treatment method described above type of tumor, the treatment of the past, such as from the general condition.
6. Survival rate
The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different.
Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.
Complications of nasal surgery, cerebrospinal fluid rhinorrhea and epistaxis postoperative: Yes (below-cerebrospinal fluid cerebrospinal fluid that quench the brain leaks from surgery portion), it is about 1%, respectively. Complications of craniotomy will remain the craniotomy by other disease. Complications of radiation, there is a failure of the pituitary gland of normal that was left, the probability of causing a pan-hypopituitarism if Mase irradiation dose in the hope that the radical increases. 10-year survival rate of pituitary adenoma as a whole is a good prognosis and almost 100%. However, those huge and 3 ~ 4cm, adenoma itself is about what hormone value was not normalized after treatment with (Cushing’s disease or acromegaly that is) adrenocorticotropic hormone secreting tumors or growth hormone regardless of the type of , not least be forced to impaired life from complications of the disease itself.
7. Life after discharge
If the pituitary hormone of normal is reduced, hormone replacement therapy is required. Able to compensate for the thyroid hormone and adrenal cortical hormone is required, you may want to oral formulations, respectively. Outpatient Required once a month if you want to continue chemotherapy. In addition, it is necessary to go to CT or MRI about once a year, to confirm the presence or absence of recurrence and tumor growth.
Cancer Breast 