Chromophobe pituitary adenoma
Endocrinology / / August 12, 2017
chromophobe adenoma pituitary usually do not produce hormones, although the "reactive" adenoma arising after the removal of the adrenal glands in patients with Cushing's syndrome - Cushing, composed of chromophobe cells containing a significant amount of ACTH.Typically, the clinical manifestations of chromophobe adenomas, sometimes reaching considerable size, associated with the pressure of the surrounding tissue.The pressure of the tumor on the adeno-pituitary and atrophy of the glandular elements of the latter can lead to anterior pituitary insufficiency, the clinical manifestations of which are listed in the "deficiency of the anterior pituitary."In rare cases, the germination of the tumor or compression of the hypothalamus leads to dysfunction of the autonomic centers in the area, which is manifested clinically development of obesity, diabetes insipidus, sleep disorders, thermoregulation, vasomotor and trophic disorders.Damage to the hypothalamic centers are often also causes secondary disorders o
Increased intracranial pressure, the pressure on the diaphragm sella and the adjacent sections of the dura mater is the cause of headaches, varying greatly in their localization and intensity.Headaches may also be associated with the pressure on large vessels.
pressure of the tumor on the optic chiasm causes of visual impairment - primarily loss of the temporal visual fields - bitemporal hemianopsia.Less frequent symptoms associated with compression of other cranial nerves - Olfactory, oculomotor, block and discharge.
In connection with the compression of the tumor or its germination vascular disease can be complicated by thrombosis and hemorrhage in the anterior pituitary or the tumor itself, which clinically manifested increased headaches, blurred vision, hyperthermia, mental stun.
Diagnosika pituitary adenoma
diagnosis hormonally inactive pituitary tumors based on clinical and laboratory detection of failure of the anterior pituitary or hypothalamic disorders centers function as well as the symptoms associated with the pressure of the tumor to the surrounding structures.
great diagnostic value has X-ray, which allows to identify the destruction of the Turkish saddle, calcification in the area of the pituitary gland.Radiographs of the skull allow you to set the size of the tumor and the direction of its growth.In assessing the x-ray data must take into account that the dimensions of sella varies considerably, and the form it is characterized by significant volatility.Sagittal size sella in adults ranging from 9 to 15 mm , vertical size - from 7 to 13 mm ) (at a focal length of the anode X-ray tube to the film equal 60 cm).
very important in the diagnosis of the disease is an eye examination, especially the definition of the fields of view of the white and colored labels.Loss of the temporal visual fields (bitemporal hemianopsia) indicates the pressure of the tumor on the optic chiasm.Color perimetry is often used to identify primary human peripheral vision than the examination with a white label.Dynamic study perimetry not only allows you to establish the presence of pituitary adenoma, but also helps to solve the question of whether tumor growth occurs.Less than a narrowing of the visual field in the presence of pituitary tumor, marked stagnation in the fundus and optic nerve atrophy.
differential diagnosis chromophobe pituitary adenoma should be carried out primarily with kraniofaringeomoy that when intrasellyarnom location may cause a very similar clinical picture - hypopituitarism, the expansion of the Turkish saddle bitemporal hemianopsia.Kraniofaringeomy often occur in childhood and adolescence, although there are also adults.Because kraniofaringeomy often located not only within the sella, but ekstrasellyarno, when they are more likely than in chromophobe pituitary adenoma, there are vegetative and trophic disorders associated with damage to the hypothalamus.On radiographs of the skull at kraniofaringeomah often - up to 80% of cases - defined shadow of calcification in the tumor area.
clinical picture of pituitary adenoma
clinical picture, which is close to that which happens in chromophobe adenoma of the pituitary gland (hypopituitarism, destruction of the sella, narrowing of the visual field), can be observed in the internal carotid artery aneurysm;The differential diagnosis in these cases helps arteriography.
- pituitary dwarfism.The clinical picture
- Cindromy defeat hypothalamic area, accompanied by violation of the production of hormones of the anterior pituitary
- Adipozo-genital dystrophy, clinical
- Morgagni syndrome - Stewart - Morel (MORGAGNI - MOREL - STEWART
- tumors of the anterior pituitary
treatment pituitary adenoma
main type of conservative treatment of hormonally inactive pituitary tumors is radiation therapy -. radiotherapy, kilocuritherapy radioactive cobalt or implantation into the tumor radioactive gold or yttrium
radiotherapy conducted large doses - single doseearly treatment of 50-100 p, rising gradually to 150-250, in the course of 4000-6000 p. at the beginning of radiotherapy may occur deterioration of general condition, increased headaches, blurred vision due to swelling of the tumor tissue.In such cases it is advisable the appointment of dehydration therapy - diuretics, magnesium sulfate intramuscular, intravenous hypertonic glucose solution or sodium chloride.
In the case of very sharp narrowing of the field of view, even when a small tumor swelling may cause irreversible changes of the optic nerve, the use of radiation therapy is risky, and is the location of the tumor is an indication for surgical intervention.
During the radiotherapy, there is also a risk weighting or revealing hidden failure of the endocrine glands, the function of which is dependent on the tropic hormones of the anterior pituitary, in particular the development of adrenal insufficiency, which makes it necessary to use replacement steroid therapy.
rare complication of radiotherapy is a tumor necrosis or hemorrhage in it.
chromophobe pituitary adenoma often resistant to radiation therapy.The indications for surgical treatment, in addition to a sharp narrowing of the visual field is disease progression despite radiotherapy.Given the possibility of adrenal insufficiency during surgery, removal of the tumor is recommended during treatment with cortisone in the same manner as in surgical interventions in patients with chronic insufficiency of the cortex.
Mortality in the surgical treatment of pituitary tumors in various statisticians from 4.2% to 19.1%.Higher mortality observed at suprasellar location of the tumor, smaller - at intrasellyarnom.
Incomplete removal of her tumor relapses.If unable to complete removal of the tumor after surgery performed antirecurrent radiotherapy courses.
flow forecast, disabled
Some patients chromophobe pituitary adenoma there for many years, others - quickly progressing, leading to the development of the endocrine, autonomic and trophic disorders and symptoms associated with compression of the surrounding tissues.
presence of intracranial tumors, even slowly growing, with no apparent pituitary insufficiency, visual disturbances, and symptoms of compression of the hypothalamus, is the basis for a disability, such as exemption from work-related physical activity.A further limitation of disability is determined by the presence of symptoms of hormone deficiency, visual impairment and symptoms of dysfunction of the hypothalamic centers.
Temporary disability is established for the duration of radiotherapy.
death of patients can occur as a result of hormonal disorders, especially adrenal insufficiency, hemorrhage into the tumor, compression of vital brain centers.Absolutely unfavorable prognosis in the presence of malignant tumors dientsefalo-pituitary region.