GeneHealth - Your precision medicine

Pituitary Adenoma

Disease Details

Family Health Simplified

Buy Membership

Description: A pituitary adenoma is a typically benign tumor that develops in the pituitary gland, which can affect hormone production and cause various health issues depending on its size and the hormones involved.
Type: Pituitary adenomas are typically benign tumors of the pituitary gland. They may occur sporadically, but there are inherited forms that follow autosomal dominant genetic transmission, such as in familial isolated pituitary adenoma (FIPA) and multiple endocrine neoplasia type 1 (MEN1).
Signs And Symptoms: Pituitary adenomas are typically benign tumors that occur in the pituitary gland. The signs and symptoms can vary widely depending on whether the tumor is secreting excess hormones (functional) or not secreting hormones (non-functional) and its size.

Common signs and symptoms include:

1. **Headaches** - Due to pressure effects.
2. **Vision problems** - Especially peripheral vision loss, as the tumor can compress the optic chiasm.
3. **Hormonal imbalances** - Depending on which hormones are affected.
- **Prolactinoma** (excess prolactin): Irregular menstrual periods in women, erectile dysfunction in men, and galactorrhea (milk secretion) in both genders.
- **Growth hormone-secreting tumors**: Acromegaly (enlarged hands, feet, facial features) in adults, or gigantism in children.
- **ACTH-secreting tumors**: Cushing's disease (weight gain, high blood pressure, diabetes, and skin changes).
4. **Fatigue and weakness** - General symptoms that can arise due to hormonal imbalances or pressure from the tumor.
5. **Nausea and vomiting** - Can occur due to increased intracranial pressure.

If the adenoma is large enough to affect surrounding tissues, it may cause additional neurological symptoms.
Prognosis: The prognosis for pituitary adenomas generally depends on factors such as tumor size, type (functional or non-functional), response to treatment, and any associated complications. Non-functional adenomas, which do not secrete hormones, often have a good prognosis, especially if detected early and treated effectively. Functional adenomas, which produce excess hormones, may have variable prognoses depending on the type of hormone involved and the effectiveness of the management. Treatments include surgery, radiation, and medication, and many patients experience significant improvement. Regular monitoring is essential for managing potential recurrences or complications.
Onset: The onset of a pituitary adenoma can vary widely. These tumors can be asymptomatic for a long time and are often discovered incidentally during imaging for other conditions. Symptoms, when they do occur, are typically due to hormonal imbalances or pressure effects on surrounding structures, such as headaches and vision problems. The onset can be gradual, developing over months to years.
Prevalence: Pituitary adenomas are relatively common, accounting for about 10-15% of all intracranial tumors. The prevalence is estimated to be approximately 77–94 cases per 100,000 people. These tumors are usually benign and can vary greatly in size and effect depending on their type and location.
Epidemiology: Regarding pituitary adenomas:

Epidemiology:
Pituitary adenomas are benign tumors that arise from the pituitary gland. They are relatively common, accounting for approximately 10-15% of all intracranial tumors. The prevalence in the general population is estimated to be around 77-94 cases per 100,000 individuals. They are usually diagnosed in adults, with peak incidence occurring between the ages of 30 and 50. There's a slight female predominance in some subtypes, such as prolactinomas. Pituitary adenomas can be functioning (hormone-secreting) or non-functioning, with prolactinomas being the most common type.

Nan:
The term "nan" is not applicable or does not provide relevant information concerning pituitary adenomas in the context of epidemiology. If there's a specific aspect of the epidemiology you're interested in, please clarify.
Intractability: Pituitary adenomas are generally not considered intractable. Most can be effectively managed or treated with a combination of surgical removal, medical therapy, and/or radiation therapy. The prognosis often depends on the size, type, and location of the adenoma, as well as its impact on surrounding tissues and hormonal balance.
Disease Severity: Pituitary adenoma is a typically benign tumor of the pituitary gland. Disease severity can vary:

1. **Microadenomas** (less than 10 mm):
- Often asymptomatic.
- May cause hormonal imbalances leading to symptoms such as menstrual irregularities or thyroid issues.

2. **Macroadenomas** (greater than 10 mm):
- Can cause more significant symptoms due to pressure on surrounding structures.
- Possible symptoms include vision problems, headaches, and more severe hormonal issues.

Severity is influenced by tumor size, hormone production, and impact on nearby structures.
Healthcare Professionals: Disease Ontology ID - DOID:3829
Pathophysiology: Pituitary adenomas are typically benign tumors that arise from the pituitary gland. The pathophysiology involves the abnormal growth of cells within the anterior pituitary, leading to either hypersecretion or hyposecretion of hormones. This can result in various clinical syndromes depending on the type of hormone affected. For example, increased secretion of prolactin can lead to prolactinoma, while excess growth hormone can cause acromegaly. Some adenomas are non-functioning and do not secrete hormones but may cause symptoms by compressing surrounding structures, such as the optic chiasm, leading to visual disturbances.
Carrier Status: Pituitary adenomas are typically not inherited in a simple carrier status manner. They are usually sporadic, meaning they occur randomly and are not passed down from parents to children. However, there are rare genetic conditions, such as Multiple Endocrine Neoplasia type 1 (MEN1), where pituitary adenomas can be part of a hereditary syndrome.
Mechanism: The pituitary gland or hypophysis is often referred to as the "master gland" of the human body. Part of the hypothalamic-pituitary axis, it controls most of the body's endocrine functions via the secretion of various hormones into the circulatory system. The pituitary gland is located below the brain in a depression (fossa) of the sphenoid bone known as the sella turcica. Although anatomically and functionally connected to the brain, the pituitary gland sits outside the blood–brain barrier. It is separated from the subarachnoid space by the diaphragma sella, therefore the arachnoid mater and thus cerebral spinal fluid cannot enter the sella turcica.The pituitary gland is divided into two lobes, the anterior lobe (which accounts for two thirds of the volume of the gland), and the posterior lobe (one third of the volume) separated by the pars intermedia.The posterior lobe (the neural lobe or neurohypophysis) of the pituitary gland is not, despite its name, a true gland. The posterior lobe contains axons of neurons that extend from the hypothalamus to which it is connected via the pituitary stalk. The hormones vasopressin and oxytocin, produced by the neurons of the supraoptic and paraventricular nuclei of the hypothalamus, are stored in the posterior lobe and released from axon endings (dendrites) within the lobe.The pituitary gland's anterior lobe (adenohypophysis) is a true gland which produces and secretes six different hormones: thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH), and prolactin (PRL).
Treatment: Treatment options depend on the type of tumor and on its size:

Prolactinomas (microadenomas and macroadenomas) are most often treated with cabergoline or bromocriptine (both dopamine agonists) as the first line of treatment. Medical treatment usually effectively decreases tumor size as well as alleviates symptoms. Pituitary adenomas are also followed by serial imaging (usually MRI) to detect any increase in size or mass effect on nearby structures. If medical therapy fails, the second option is usually transphenoidal pituitary surgery. A third line therapy is radiation therapy, proton therapy to shrink the tumor.
Thyrotropinomas are treated with transsphenoidal pituitary surgery as the first line treatment option. Medical therapy is a second line treatment, and thyrotropinomas respond to treatment with somatostatin receptor ligands such as octreotide or lanreotide. In people with thyrotropinomas, treatment with somatostatin receptor ligands normalized thyroid hormone levels in 80-90% of people, and 42% of people had a decreased tumor size.
Somatotrophic adenomas are primarily treated with transsphenoidal pituitary surgery, especially if symptoms of acromegaly are present. A second line treatment strategy (which can be used if there is a persistent or recurrent mass or symptoms after surgery) utilizes medical therapy, including octreotide or lanreotide, which are long-acting somatostatin analogs. These somatostatin receptor analogs inhibit secretion of growth hormone. They were found to be about 50–55% effective in reducing tumor mass and reducing growth hormone and insulin like growth factor 1 (IGF-1) levels in studies. The growth hormone receptor antagonist pegvisomant is also used in the treatment of somatotrophic adenomas. Pegvisomant blocks the action of growth hormone. It can either be used as monotherapy or combined with a somatostatin analog.
Corticotropinomas are primarily treated with transsphenoidal pituitary surgery, especially if signs and symptoms of Cushing syndrome are present. Medication therapy is second line, and includes steroidogenesis inhibitors (ketoconazole, metyrapone, osilodrostat, etomidate or mitotane) which decrease production of cortisol, pituitary blockers such as somatostatin receptor ligand pasireotide or the dopamine agonist cabergoline, or the glucocorticoid receptor antagonist mifepristone. These medications can be combined for a synergistic effect. Medication therapy is often used in conjunction with radiation therapy for corticotropinomas.
Surgery is a common treatment for pituitary tumors. The normal approach is trans-sphenoidal adenectomy, which usually can remove the tumor without affecting the brain or optic nerves.
Radiation is also used to treat pituitary adenomas. Examples include external beam or proton beam radiation therapy or stereotactic radiosurgery. External radiation of pituitary adenomas can arrest tumor growth for several years but pituitary failure develops within 10 years in most patients necessitating lifelong hormone replacement. Radiation therapy for pituitary adenomas is associated with a four-fold increase in mortality due to cerebrovascular disease. Lifelong monitoring of pituitary hormones is recommended after radiation therapy as hypopituitarism developed in 17% of those undergoing radiation therapy.
Compassionate Use Treatment: Compassionate use treatment for pituitary adenoma can include the administration of investigational drugs or therapies that have not yet received formal approval. These treatments are accessible under specific protocols, often when standard therapies have failed and the patient has no other treatment options.

Off-label or experimental treatments for pituitary adenoma may include:

1. **Temozolomide**: An oral chemotherapy drug typically used for glioblastoma, but sometimes used off-label for aggressive or refractory pituitary adenomas.
2. **Pasireotide**: A somatostatin analog that may be used off-label for recurrent or persistent Cushing’s disease caused by a pituitary adenoma.
3. **Everolimus**: An mTOR inhibitor, occasionally used experimentally for its anti-tumor effects on pituitary adenomas.
4. **Lapatinib**: A dual tyrosine kinase inhibitor that is being investigated for its potential efficacy against pituitary tumors.

Experimental treatments often include participation in clinical trials investigating new drugs, drug combinations, or novel therapeutic approaches. It's important for patients to discuss these options with their healthcare provider to evaluate the potential benefits and risks.
Lifestyle Recommendations: Here are some lifestyle recommendations for individuals with a pituitary adenoma:

1. **Regular Monitoring:** Keep up with regular check-ups, including MRI scans and blood tests, as recommended by your healthcare provider to monitor the tumor's growth and hormone levels.

2. **Medication Adherence:** If prescribed medications to manage hormone levels or tumor size, take them exactly as directed.

3. **Healthy Diet:** Maintain a balanced diet rich in fruits, vegetables, lean proteins, and whole grains to support overall health.

4. **Stay Hydrated:** Drink plenty of water throughout the day.

5. **Manage Stress:** Practice stress-reducing techniques such as yoga, meditation, or deep-breathing exercises.

6. **Exercise Regularly:** Engage in moderate physical activity, such as walking or swimming, to maintain overall well-being and assist with any side effects of treatment.

7. **Avoid Alcohol and Smoking:** These can exacerbate health issues and interfere with medication effectiveness.

8. **Sleep Hygiene:** Ensure you get enough restful sleep each night to help your body heal and function properly.

9. **Report Symptoms:** Immediately report any new or worsening symptoms to your healthcare provider, such as changes in vision, headaches, or hormonal imbalances.

10. **Support System:** Engage with support groups or counseling to help cope with the emotional aspects of the condition.
Medication: For pituitary adenomas, medical treatment may include medications that manage hormone levels or inhibit tumor growth. The commonly used medications are:

1. **Dopamine agonists** (e.g., bromocriptine, cabergoline) - primarily for prolactinomas.
2. **Somatostatin analogs** (e.g., octreotide, lanreotide) - mainly for acromegaly caused by growth hormone-secreting tumors.
3. **Growth hormone receptor antagonists** (e.g., pegvisomant) - also used for acromegaly.
4. **Hormone replacement therapy** - if the adenoma causes hormone deficiencies.

These treatments aim to control symptoms, reduce tumor size, and normalize hormone levels.
Repurposable Drugs: Pituitary adenomas are benign tumors of the pituitary gland. While the first-line treatments often include surgery and radiotherapy, several repurposable drugs have shown potential for managing these tumors. Some of these drugs include:

1. **Cabergoline and Bromocriptine**: Dopamine agonists primarily used to treat prolactin-secreting pituitary adenomas (prolactinomas).
2. **Octreotide and Lanreotide**: Somatostatin analogs used to manage growth hormone-secreting adenomas (acromegaly).
3. **Pasireotide**: Another somatostatin analog that may be effective for patients who do not respond to standard treatments.
4. **Mifepristone**: A glucocorticoid receptor antagonist used for Cushing's disease related to ACTH-secreting adenomas.
5. **Temozolomide**: An alkylating agent often repurposed in aggressive, resistant cases of pituitary adenomas.

Please consult with a healthcare professional for more personalized recommendations and treatment options.
Metabolites: For pituitary adenoma, the metabolite profiles can show changes in certain biochemical markers. Commonly altered metabolites include:

1. **Lactate**: Increased levels may indicate altered glycolysis and hypoxia within the tumor.
2. **Glutamate**: Elevated levels can be associated with rapid cell proliferation.
3. **Choline-containing compounds**: Often increased, reflecting cell membrane turnover.
4. **Lipids**: Changes in lipid metabolism might be observed in pituitary adenomas.

These metabolic alterations can be studied using techniques like magnetic resonance spectroscopy (MRS).
Nutraceuticals: There is limited scientific evidence supporting the use of specific nutraceuticals for the treatment of pituitary adenoma. Nutraceuticals are products derived from food sources that provide health benefits in addition to their basic nutritional value. While some might suggest various dietary supplements, vitamins, or herbal products to support overall health or potentially impact tumor growth, these should not replace conventional medical treatments.

Management of a pituitary adenoma typically involves a combination of approaches, including medical therapy, surgery, and radiation therapy. If considering any nutraceuticals, it's important to consult with a healthcare provider to ensure they do not interfere with standard treatments.
Peptides: Peptides play a role in the diagnosis and treatment of pituitary adenomas. For instance, somatostatin analogs (such as octreotide) are peptides that can be used to manage symptoms and control tumor growth, particularly in hormonally active adenomas like growth hormone-secreting or ACTH-secreting adenomas. Nanotechnology (nan) is increasingly being explored for its potential in delivering targeted therapies, improving imaging techniques, and enhancing diagnostic accuracy for pituitary adenomas.