Procedure for Pituitary Macro Adenoma

What is Pituitary Macro Adenoma?

Macroadenoma is a benign type of a tumour and it is a glandular tissue growth larger than 1cm. hence they are called large tumours. When such tumours occur in pituitary gland it is known as Pituitary Macro adenoma.

The pituitary gland is a small gland present in the midbrain. The pituitary gland is controlled by the hypothalamus gland. A pituitary tumour can occasionally act like a cancerous tumour by growing into nearby tissues and other brain structures, or rarely, even spread to other parts of the body like lungs, kidney, breast and heart. Also this can cause an enlarged pituitary gland which disrupts the hormonal functions leading to pituitary gland disorders.

What are the Risk Factors of Pituitary Macro Adenoma (PMA)?

While the cause for the PMA is still unknown; following are a few risk factors for PMA

• A family history of pituitary gland tumour
• Acquired genetic mutations due to exposure to radiation or cancer-causing chemicals.
• Common in females than men, especially seen in females in the maternal age.
• Hay fever
• Childbirths at young age
• Surgically induced menopause,
• Early postmenopausal age

Pituitary Tumour Symptoms

Some pituitary tumours might cause symptoms while some are symptomless. Symptoms occur due to two main reasons.

1. The macroadenoma can create pressure against pituitary gland and the nearby structures in the brain
2. By hormonal deficiencies.

   Hormonal deficiencies can cause different types of symptoms depending on the hormone affected. The hormones that are usually affected by PMA are:

   • Growth hormone
   • Thyroid stimulating hormone
   • Prolactin hormone
   • Adrenocorticotropic hormone

Symptoms due to the pressure of macroadenoma:

• Loss of consciousness (passing out) accompanied with dizziness and headache.
• Problems in eyesight: double vision, loss of peripheral vision, sudden blindness.
• Facial numbness or pain.

Symptoms due to pituitary gland disorders related to hormonal imbalance

• Sudden weight loss or weight gain.
• Nausea and vomiting.
• The increased amount of urine.
• The general weakness of the body, tiredness.
• Menstrual changes and changes in the breast in women.
• Erectile dysfunction and decreased interest in sex in men.

How to Diagnose Pituitary Macro Adenoma?

Pituitary tumours can be identified through a careful physical examination followed by a neurological examination. Furthermore, tests like biochemical testing, MRI and biopsy are can be done.

• Biochemical testing and hormonal testing is used to measure hormonal levels in blood and urine. Pituitary disorders lead to excess secretion of hormones into the bloodstream.
• Imaging scans like pituitary MRI can easily identify pituitary macroadenoma due to its large size. Most advanced type of imaging method is positron emission tomography (PET) scan. Special radioactive dye is used for the imaging.
• A biopsy is used to identify the type of a tumour.

Treatment for Pituitary Macro Adenoma

The initial line of treatment is hormonal therapy, which can control the hormonal secretion or block the action of the macroadenoma caused by pituitary gland disorders.

One of the commonly used treatment methods is radiotherapy. Tumours are destroyed by high-frequency radiation waves. This is usually advised when symptoms are not relieved through oral medications and hormonal therapies.

Chemotherapy is another type of pituitary gland treatment for PMA with an objective of reducing the over-production of hormones from the pituitary gland, or block the effects of these hormones.

pituitary macro Adenoma Surgery is the best option for Pituitary tumour treatment. In a surgical intervention, the tumour is removed through the nasal cavity. Subsequently, the tumour cavity is cleaned and finally sealed. This surgical procedure includes microsurgery and endoscopic surgery. However, its effectiveness still depends on type size and location of the pituitary gland tumour.

Additionally, gamma knife radiosurgery is a highly advanced type of radiotherapy used to obtain similar results of surgical techniques. However, it takes years to resolve pituitary gland disorders in comparison to surgery.