From the Guidelines
Pituitary adenomas can cause a range of symptoms, including headaches, vision problems, fatigue, and hormonal imbalances, which can be life-changing and life-limiting, and thus, require prompt diagnosis and treatment by a pituitary-specific multidisciplinary team (MDT) to improve quality of life and reduce morbidity. According to the most recent consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence, published in 2024 in Nature Reviews Endocrinology 1, pituitary adenomas are neoplasms arising from the hormone-secreting cells of the anterior pituitary, and they often secrete hormones in excess, leading to characteristic signs and symptoms.
Common Symptoms
- Headaches
- Vision problems (particularly peripheral vision loss or double vision)
- Fatigue
- Hormonal imbalances Hormone-producing adenomas may cause specific syndromes, such as:
- Prolactinomas: irregular menstruation, breast milk production in non-pregnant women, and decreased libido
- Growth hormone-producing tumors: acromegaly with enlarged hands, feet, and facial features
- ACTH-producing tumors: Cushing's disease with weight gain, muscle weakness, and easy bruising
- TSH-producing tumors: hyperthyroidism symptoms like anxiety, weight loss, and heart palpitations Non-functioning adenomas typically cause symptoms through pressure on surrounding structures as they grow, and large tumors (macroadenomas) are more likely to cause headaches and visual disturbances due to compression of the optic chiasm.
Diagnosis and Treatment
Diagnosis typically involves blood tests to measure hormone levels, MRI imaging, and visual field testing, as recommended by the consensus guideline 1. Treatment options include medication, surgery, radiation therapy, or a combination approach depending on the tumor type and symptoms, and should be managed by a pituitary-specific MDT to achieve optimal care and improve quality of life. It is essential to note that pituitary adenomas have a high survival rate, but they can confer potentially serious, life-changing, and life-limiting sequelae, and thus, require prompt and appropriate management to reduce secondary and long-term health-related morbidity 1.
From the Research
Pituitary Adenoma Symptoms
Pituitary adenomas can cause a variety of symptoms due to hormone hypersecretion or mass effects. The symptoms of pituitary adenomas include:
- Headache
- Hypopituitarism
- Visual field defects
- Infertility
- Loss of libido
- Galactorrhea
- Acromegaly (enlargement of the lips, tongue, nose, hands, and feet)
- Cushing disease (obesity, hypertension, diabetes)
- Hyperthyroidism
Functioning and Nonfunctioning Adenomas
Pituitary adenomas can be classified as functioning or nonfunctioning. Functioning adenomas secrete excess hormones, while nonfunctioning adenomas do not produce hormones. The most common types of functioning adenomas are:
- Prolactinomas (secrete prolactin) 2, 3, 4
- Somatotropinomas (secrete growth hormone) 2, 3
- Corticotropinomas (secrete adrenocorticotropic hormone) 2, 3
- Thyrotropinomas (secrete thyroid-stimulating hormone) 2, 3
Diagnosis and Treatment
Diagnosis of pituitary adenomas typically involves imaging studies (such as MRI or CT scans) and endocrine evaluation for hormone hypersecretion 2, 3, 4. Treatment depends on the type of adenoma and may include:
- Transsphenoidal surgery 2, 3
- Medical therapy (such as dopamine agonists for prolactinomas) 2, 3, 4
- Radiotherapy 2
Specific Treatment for Prolactinomas
Prolactinomas are typically treated with dopamine agonists, such as bromocriptine or cabergoline 2, 3, 4. However, large doses or long-term use of bromocriptine may increase surgical difficulties and postoperative complications 5.