Pituitary Adenoma

Located at the base of brain, a few cm behind the root of nose, and having settled in a bony hollow of 1 cm in size, the pituitary gland is the center for hormone regulation in our body. The front part of it is formed by brain’s extension down and the back part of it is formed by the indent which developed upwards from pharynx. It is an exceptional organ as it is both inside and outside the brain. Inside, there are cells which do and do not secrete hormones. They present symptoms either due to the side effects of the hormones they secrete or due to the compression of mass on the surrounding area. Those which are smaller than 1 cm are called “microadenoma” and those larger than 1 cm are called “macroadenoma”. Those which secrete hormones are called “hormonally active (functional adenomas)” and those that do not secrete hormones are called “hormonally inactive (nonfunctional adenoma). These are benign tumors except for the ones on the brain axe. Pituitary adenomas may rarely be malignant.

Who can get pituitary adenoma?

It occurs both in males and females generally between the ages 25-45. It may also occur at earlier or later stages of life as well.

How does pituitary adenoma develop?

When the cells which do/do not release hormones –acting outside the chain of command- multiply and form a mass (the tumor), it is called “adenoma”.

What are the symptoms of pituitary adenoma?

The cells which secrete hormone, regardless of their size, show themselves through the side effects – on the body- of the hormones they secrete. For instance, the excess hormone secreted by the adenoma of the cells which secrete prolactin that produces milk in the puerperant causes unnecessary milk release and menstrual irregularities in pre-menopause females. The adenoma of the cells that produce cortisol causes the Cushing disease due to the excess cortisol (moon face, obesity, diabetes, hypertension etc.). The adenoma of the cells that secrete growth hormone causes huge growth in humans (gigantism) if the patient is in a fast-growth period, or causes extending of hands and feet, heart failure, diabetes etc. if the patient is an adult. Rarely, the adenoma of the cells which secrete thyroid hormone presents symptoms of hypothyroid or hyperthyroidism.

Regarding the cells which do not secrete hormones, the mass formed compresses on pituitary gland and causes pituitary gland fail, which results in hormone deficiencies, problems in sexual functions both in males and females, infertility, thamuria, and partial or complete loss of vision if presses on the optic nerve. And large size endocrine active tumors may also produce the same compression symptoms as the others.

Rarely, those which are malign – and growing faster and larger – present themselves with symptoms that increase intracranial pressure.

What is the treatment applied by Dr. Yunus Aydın?

Most of over 1000 pituitary adenoma surgeries were carried out by entering through the nose (endo nasal transphenoidal), and by using a microscope. And for the rare cases in which pituitary adenoma grow aggressively and can not be removed through the nose, cranial discectomy is applied. For large tumors, we perform endoscopy in addition to the surgical microscope. As I have had huge experience, I do not use endoscope during the surgery.

I use the same method also for the recurring cases.

What are the other treatment methods for pituitary adenoma?

There are colleagues who carry out surgery based completely on endoscopic method without using a microscope. Endoscopy has a disadvantage as it provides 2 dimensional pictures, but it also has an advantage as it shows the lateral grooves not shown in a microscope. I use only this advantage it provides, and I use endoscopy for the places not shown by microscopy. I also can not ignore the three dimensional advantage of a microscope.

One can use gamma ray for the adenomas which did not allow for removal and for those which were left in margins or behind blood vessels.

The adenomas which secrete prolactin can be treated with medication. This treatment prevents cells from secreting, reduces their sizes, removes the excess hormones – produced for the period of medication – and improves the symptoms caused by those excess hormones (menstrual irregularities etc.). However, it will not remove the tumor completely. Surgical scar remains in young patients who want to conceive a baby.

There is also medication for the adenomas that secrete growth hormone, however medication is given to reduce the secretion of the tumor which has been left behind in spite of the surgery. Also, gamma ray can be used.

The ideal treatment in the Cushing adenoma would be a complete surgical removal, however if the required cortisol level can still not be reached, the entire pituitary gland is removed surgically or gamma ray can be used for the same purpose.

And gamma ray can also be used for the adenomas which do not secrete hormone. For these, medication does not work, in practical terms.

What if pituitary adenoma is not treated?

Each of the side effects of the diseases that develop due to excessive hormone secretion is experienced. The hypertension caused by the Cushing adenoma causes problems and the diabetes damages the blood vessel system, also causing kidney disease.