What are the symptoms and treatment options for pituitary adenoma?

Symptoms of Pituitary Adenoma

Pituitary adenomas present with symptoms related to hormonal hypersecretion, mass effect, and hypopituitarism, with specific manifestations depending on tumor size, location, and functional status. 1, 2

Symptoms Due to Mass Effect

• Headache is a common symptom, especially with macroadenomas (≥10 mm) 2, 3
• Visual disturbances occur due to compression of the optic chiasm, including visual field defects (typically bitemporal hemianopsia) and central vision loss 2, 1
• Deterioration of vision is an urgent indication for surgical decompression and requires prompt evaluation 2
• Large tumors (>4 cm, "giant adenomas") cause more severe mass effects and have higher surgical complexity 4

Symptoms Due to Hormonal Hypersecretion

Prolactinomas (53% of pituitary adenomas) 3

• In women: delayed or arrested puberty, amenorrhea, galactorrhea, menstrual irregularities, and infertility 2, 1
• In men: hypogonadism, decreased libido, erectile dysfunction, and gynecomastia 2, 5

Somatotropinomas (Growth Hormone-secreting, 12% of adenomas) 3

• In adults: acromegaly with enlargement of the lips, tongue, nose, hands, and feet 3, 6
• In children: gigantism 2, 7
• Diagnosis can be difficult during puberty 2

Corticotropinomas (ACTH-secreting, 4% of adenomas) 3

• Cushing's disease with hypercortisolemia 2, 6
• More prevalent in young boys under 10 years than in girls 2
• Features include central obesity, moon facies, buffalo hump, purple striae, hypertension, and diabetes 6

Thyrotropinomas (TSH-secreting, 1% of adenomas) 2

• Secondary hyperthyroidism with symptoms of thyrotoxicosis 2, 6

Symptoms Due to Hypopituitarism

• Growth delay or short stature due to growth hormone deficiency 2
• Delayed or arrested puberty due to gonadotropin deficiency 2
• Hypothyroidism causing fatigue, cold intolerance, and weight gain due to TSH deficiency 2
• Hypocortisolism causing fatigue, weakness, and hypotension due to ACTH deficiency 2
• Hypopituitarism is common in patients with non-functioning macroadenomas 2, 1

Age and Sex-Specific Considerations

• Pituitary adenomas are 3-4.5 times more common in women than in men, although non-functioning adenomas show no sex predisposition 2
• In children and adolescents, tumors tend to present more occultly and with more aggressive behavior than in adults 1, 2
• Higher likelihood of genetic basis in children and young individuals than in adults 1, 2
• Pituitary adenomas increase in incidence during late adolescence 1

Non-Functioning Pituitary Adenomas (30% of adenomas) 3

• Microadenomas are often asymptomatic and discovered incidentally on imaging studies 2
• Macroadenomas present with mass effects including headache, visual field defects, and hypopituitarism 1, 2
• Central diabetes insipidus is extremely rare at diagnosis of a non-functioning adenoma 2

Diagnostic Approach

• Visual evaluation is critical for any suspected pituitary macroadenoma, including visual acuity, visual field testing, and assessment of optical nerve integrity 1, 2
• MRI with high-resolution pituitary protocols is the gold standard for imaging the pituitary gland 1
• Endocrine evaluation is necessary to assess for hormone hypersecretion and hypopituitarism 3
• Genetic testing should be considered in children and young individuals with pituitary adenomas 1, 2

Treatment Options

• For prolactinomas: dopamine agonists (cabergoline or bromocriptine) are first-line therapy 1, 8, 3
• For other functioning adenomas and symptomatic non-functioning adenomas: transsphenoidal surgery is generally the first-line treatment 3, 6
• For large tumors with visual compromise: urgent surgical decompression may be required 2
• Radiation therapy is considered for tumors with postoperative residue and resistance to medical therapy 2, 6
• Multidisciplinary approach involving neurosurgeons and endocrinologists is essential for optimal management 9