غده هیپوفیز یکی از مهمترین غدد بدن است که کنترل عمده فعالیت‌های بدن را با ترشح هورمون‌ها در دست دارد. تومور آدنومای هیپوفیز یکی از اختلالات هیپوفیز است که بر ترشح این هورمون‌ها تاثیر منفی گذاشته و نهایتا در عملکرد بدن اخلال ایجاد می‌کند. همه تومورهای هیپوفیز (که آدنوم‌های هیپوفیز نامیده می‌شوند) باعث ایجاد علائم نمی‌شوند. ممکن است این بیماری علائمی در بیمار ایجاد نکند. اولین علامت آدنوم هیپوفیز اغلب به این بستگی دارد که آیا تومور عملکردی است (هورمون‌های اضافی تولید می‌کند) یا غیر عملکردی (هورمون‌های اضافی تولید نمی‌کند).

علل ایجاد تومور هیپوفیز

دانشمندان دقیقا نمی‌دانند که چه چیزی باعث ایجاد تومورهای هیپوفیز می‌شود. در طول چند سال گذشته، آن‌ها پیشرفت زیادی در درک اینکه چگونه تغییرات خاصی در DNA یک فرد می‌تواند باعث ایجاد تومور توسط سلول‌های هیپوفیز شوند، داشته‌اند. DNA ماده شیمیایی درون هسته هر یک از سلول‌های ماست که ژن‌های ما را تشکیل می‌دهد (دستورالعمل‌هایی برای چگونگی عملکرد سلول‌های ما). ما معمولا شبیه به پدر و مادرمان هستیم؛ زیرا آن‌ها منبع DNA ما هستند. اما تاثیر DNA بیش از تصور اولیه ما است. برخی از ژن‌ها کنترل می‌کنند که سلول‌ها چه زمانی رشد کنند، به سلول‌های جدید تقسیم شوند و بمیرند. ژن‌هایی که به رشد سلول‌ها، تقسیم شدن و زنده ماندن آ‌ن‌ها کمک می‌کنند، آنکوژن نامیده می‌شوند. ژن‌هایی که سرعت تقسیم سلول را کاهش می‌دهند یا باعث مرگ سلول‌ها در زمان درست می‌شوند، ژن‌های سرکوب کننده تومور نامیده می‌شوند. تومورها می‌توانند در اثر تغییرات DNA ایجاد شوند که آنکوژن‌ها را فعال می‌کنند یا ژن‌های سرکوب کننده تومور را غیر فعال می‌کنند.

برخی افراد جهش‌های ژنی (تغییرات) را از والدین خود به ارث می‌برند که خطر ابتلا به تومورهای هیپوفیز را افزایش می‌دهد. برخی از این جهش‌ها در بخش عوامل خطر برای تومورهای هیپوفیز توضیح داده شده اند. اعضای خانواده‌های دارای این سندرم‌های ژنتیکی می‌توانند آزمایش ژنتیکی انجام دهند تا دریابند آن‌ها مبتلا به تومور خواهند شد یا خیر. اما اغلب، جهش‌های ژنی در طول زندگی رخ می‌دهد تا اینکه به ارث برده شوند. در برخی از انواع سرطان، این جهش‌های اکتسابی می‌تواند در اثر قرار گرفتن در معرض عوامل خارجی مانند اشعه یا مواد شیمیایی مولد سرطان ایجاد شوند. Most pituitary tumors are not cancerous and there is no known environmental cause for these tumors. The gene changes in these tumors may just be random events that sometimes occur during cell division without an external cause.

What is clear is that the regulatory mechanism that normally prevents pituitary cells from growing and producing too much hormone is disrupted. Because there are no known lifestyle or environmental causes for pituitary tumors, it's important to remember that there is nothing people with these tumors can do to prevent it.

Pituitary Tumor Signs and Symptoms

Functional adenomas can cause problems because of the hormones they release. Often times, a functional adenoma causes an excess of pituitary hormone. These tumors are often found while they are still relatively small (microadenomas). Symptoms of functional adenomas based on the hormones they produce are described below. Tumors that do not make extra hormones (non-functioning adenomas) often grow large before they are detected (macroadenoma). These tumors do not cause symptoms until they press on nearby nerves, parts of the brain, or other parts of the pituitary gland. A nonfunctioning adenoma that doesn't cause symptoms is sometimes diagnosed with an MRI or CT scan for other reasons. These tumors are being found more often now because more MRI and CT brain scans are being done. These tumors may be the most common pituitary tumors. Because they do not cause problems, they are often just monitored regularly without the need for treatment.

Large tumors (macroadenomas) and pituitary carcinomas

Pituitary macroadenomas (benign tumors larger than 1 cm) and carcinomas (cancerous tumors), whether functional or not, can grow large enough to Adjacent nerves or parts of the brain put pressure. This condition can lead to symptoms including:

• Eye muscle weakness, so that the eyes do not move in the same direction at the same time
• Blurred vision or diplopia
• Loss of peripheral vision
• Sudden blindness
• Headache
• Numbness or pain in the face
• Dizziness
• Loss of consciousness (unconsciousness)

Visual problems occur when a tumor compresses the nerves between the eye and the brain. Sudden loss of vision, loss of consciousness and even death are caused by sudden bleeding in the tumor. Pituitary macroadenomas and carcinomas can also compress and destroy normal parts of the pituitary gland. This causes a deficiency of one or more pituitary hormones. Low levels of certain body hormones such as cortisol, thyroid hormone, and sex hormones cause symptoms. Depending on the hormones affected, symptoms may include:

• nausea
• weakness
• unexplained weight loss or gain
• loss of body hair
• feeling cold
• feeling tired or weak
• menstrual changes or missing periods in women
• erectile dysfunction (difficulty in Erection) in men
• Growth of breast tissue in men
• Decreased libido, mostly in men

Diabetes insipidus

Large tumors may sometimes press on the posterior (back) part of the pituitary gland and cause a deficiency of the hormone vasopressin (also known as antidiuretic hormone or ADH). This can lead to diabetes insipidus. In this condition, too much water is lost through urine, so the person urinates frequently and becomes very thirsty as the body tries to adjust to the loss of water. If left untreated, it can cause dehydration and changes in blood mineral levels that can lead to coma and even death. Diabetes insipidus is easily treated with a drug called desmopressin, which replaces vasopressin. (Diabetes insipidus is not related to type 1 diabetes, in which people have high blood sugar levels.)

Growth hormone-secreting adenoma (somatotrophic adenoma)

The main symptoms of these tumors are caused by having too much growth hormone (GH). These effects are relatively different in children and adults. In children, high levels of GH can stimulate the growth of almost all bones in the body. The medical term for this condition is gigantism. Symptoms include:

• Extremely tall
• Extremely fast growth
• Joint pain
• Increased sweating

In adults, long bones (especially in the hands and feet) can no longer grow, even when GH levels are very high. Therefore, these bones do not grow longer and gigantism does not occur. But the bones of the hands, feet and the face of an adult person can grow throughout life. This causes a condition called acromegaly. The signs and symptoms are:

• Growth of the skull, hands and feet, leading to an increase in the size of hats, shoes, gloves and rings
• Hoarseness of the voice

Change in facial appearance (due to the growth of the facial bones)

• More distance between the teeth and forward jaw (due to the growth of the jawbone)
• Increased joint pain
• Sweating
• High blood sugar or even diabetes
• Kidney stones
• Heart disease
• Headache
• Visual changes
• Numbness or tingling in hands or feet
• Thickening of the tongue and roof of the mouth, which leads to sleep disorders such as snoring and sleep apnea (pause in breathing)
• Thickening of the skin
• Increased hair growth Body

Many of these changes can happen slowly, and people may not notice them until they look at an old picture of themselves or try on a hat or ring they haven't worn in years. produce cortisol. Having too much of this hormone causes symptoms that doctors classify as Cushing's syndrome. When the cause is overproduction of ACTH from the pituitary gland, the condition is called Cushing's disease. In adults, symptoms may include the following:

• weight gain (mostly on the face, chest, and abdomen)
• purple stretch marks on the chest or abdomen
• new or increased hair growth (on the face, chest, or abdomen)
• facial swelling and redness
• acne
• extra fat on the back of the neck
• mood swings or Depression
• Headaches
• Visual changes
• Easy bruising
• High blood sugar levels or even diabetes
• High blood pressure
• Decreased desire for sex
• Changes in menstrual periods in women
• Weak bones, which can lead to osteoporosis or even fractures

Many of these symptoms may occur in children. also occur. Children with Cushing's disease may also have stunted growth and have problems with their academic performance.

Prolactin-secreting adenoma (prolactinoma or lactrotrophic adenoma)

Prolactinoma is more common in young women and older men.

• In premenopausal women, high prolactin levels cause periods to become fewer or stop. High prolactin levels can also cause an abnormal production of breast milk, called galactorrhea.
• In men, high prolactin levels can cause breast growth and erectile dysfunction (difficulty getting an erection)
• Both men and women can have the following symptoms:
  • Loss of sex drive
  • Infertility
  • Weakness of bones called osteoporosis

If the tumor continues to grow, it can put pressure on nerves and parts of the brain, which can cause headaches and vision problems. In women who do not have periods (such as prepubescent girls and postmenopausal women), prolactinoma may go undiagnosed until symptoms develop. Due to the fact that prolactinoma is more common, we will discuss it further.

Thyrotropin-secreting adenoma (thyrotrophic adenoma)

These rare tumors cause an excess of thyroid-stimulating hormone (TSH), which in turn prompts the thyroid gland to produce too much thyroid hormone. This condition can cause symptoms of hyperthyroidism (overactive thyroid), including:

• fast or irregular heartbeat
• tremors
• weight loss
• increased appetite
• feeling warm or hot
• sweating
• difficulty sleeping
• anxiety
• frequent bowel movements
• having Lump in the front of the neck (enlarged thyroid)

Gonadotropin-secreting adenoma (gonadotroph adenoma)

These rare tumors produce luteinizing hormone (LH) or follicle-stimulating hormone (FSH). This hormone can cause irregular menstrual periods in women or low testosterone levels and decreased libido in men. Many gonadotropin-secreting adenomas do not actually produce enough hormones to cause symptoms, so they are essentially inactive adenomas. These tumors may grow large enough to cause symptoms such as headaches and vision problems before they are diagnosed.

Treatment

Almost all pituitary tumors are adenomas and not cancerous (benign). Treatment for a pituitary adenoma depends on whether it's producing extra hormones, and if so, what hormones it's producing. Treatment also depends on whether it is a microadenoma (smaller than 1 cm) or a macroadenoma (1 cm or larger).

Treatment for pituitary tumors may include:

• Surgery
• Drugs that prevent the tumor from making hormones or help prevent problems caused by these hormones
• Radiation therapy

Sometimes A combination of treatments is used. For example, surgery may be performed to remove part of the tumor, while medications may be used to relieve symptoms and sometimes shrink the remaining tumor. Treatment plans vary depending on the type of tumor:

• Functional tumors
• Non-functioning tumors
• Cancer

Your doctor will discuss treatment options with you. It's important to take the time to think about your options, weighing the benefits of each option against its potential risks and side effects. Also, if you have a question that you are not sure about, it is important to ask.

No matter what treatment you choose, it should be done by doctors who are experienced in treating pituitary tumors. Pituitary tumors often require the care of a medical team. Doctors on your team may include:

• a neurosurgeon:a doctor who uses surgery to treat brain and pituitary tumors
• an endocrinologist:a doctor who treats diseases of the glands that make hormones
• a neurologist:medical that diagnoses and treats diseases of the brain and nervous system
• Radiotherapy: A doctor who uses radiation to treat cancers and other tumors
• Medical oncologist:A doctor who uses chemotherapy and other drugs to treat cancers and other tumors

Many other professionals, including physician assistants, head nurses, A nurse, psychologist, social worker, rehabilitation specialist, and other medical professionals may be part of your treatment team.

Surgery

The main treatment for many pituitary tumors is surgery. The success of surgery depends on the type of tumor, its exact location, its size and whether it has spread to nearby structures or not.

Transsphenoid surgery

This operation is the most common way to remove pituitary tumors. Transsphenoid means that the surgery is performed through the sphenoid sinus, the empty space in the skull behind the nasal airways and under the brain. The back wall of the sinus covers the pituitary gland. To perform this operation, the neurosurgeon makes a small incision along the septum (blade) of the nose (cartilage between the two sides of the nose) or under the upper lip (above the teeth). To access the pituitary gland, the surgeon opens the bony walls of the sphenoid sinus using small surgical chisels, drills, or other instruments, depending on the thickness of the bone and sinus. Small instruments and a microscope are used to remove the tumor.

Another method is to use an endoscope, a thin fiber-optic tube with a small camera at the end. In this way, an incision under the upper lip or along the nasal septum is not necessary, as the endoscope allows the surgeon to see inside through a small incision made behind the nasal septum. The surgeon inserts the instrument into the nose and opens the sphenoid sinus to reach the pituitary gland and remove the tumor. Whether this method can be used or not depends on the location of the tumor and the shape of the sphenoid sinus. The transsphenoidal approach has many advantages. First, no part of the brain is touched during the surgery, so the chance of damaging the brain is very low. It may have less side effects and also there is no visible scar. But the operation may take longer, making it difficult to remove large tumors.

When the surgery is performed by an experienced neurosurgeon and the tumor is small (microadenoma), the cure rate is high (more than 80%). If the tumor is large or has spread to nearby structures (such as nerves, brain tissue, or tissues that cover the brain), it is less likely to be cured and more likely to damage nearby brain tissue, nerves, and blood vessels.

Craniotomy and opening the skull

For larger or more complex pituitary tumors, a craniotomy may be needed. In this method, the surgeon performs the operation by opening the front of the skull to one side of the head. The surgeon must carefully maneuver under and between the brain's hemispheres to reach the tumor. For small lesions, craniotomy is associated with a greater chance of brain damage and other side effects than transsphenoidal surgery, but for large and complex lesions, it is safer because the surgeon will be better able to see the tumor as well as nearby nerves and blood vessels.

Prolactinoma

Prolactinoma is a disease in which A non-cancerous tumor, called a pituitary adenoma, grows in the pituitary gland of the brain and produces too much of the hormone prolactin. The main effect of this disease is to decrease the level of sex hormones estrogen in women and testosterone in men. Although prolactinoma is not life-threatening, it can adversely affect vision, cause infertility, and cause other effects. Prolactinoma is the most common type of hormone-producing tumor that can develop in the pituitary gland. Doctors can often treat prolactinoma with medication to bring prolactin levels back to normal. Surgery to remove the pituitary tumor may be another treatment option.

Prolactinoma is one type of tumor that develops and grows in the pituitary gland. The cause of this tumor is unknown. The pituitary gland is a small bean-shaped gland located under the brain, and despite its small size, it affects almost all parts of the body. Hormones secreted by the pituitary gland help regulate important functions such as growth, blood pressure, and reproduction. Among the possible causes of excessive production of prolactin are: drugs, other types of pituitary tumors, hypothyroidism, chest damage, pregnancy and breastfeeding.

Symptoms of high prolactin

Prolactinoma disease does not have significant signs or symptoms. However, the presence of too much prolactin in the blood (hyperprolactinemia) or the pressure that a large tumor puts on surrounding tissues can lead to complications and symptoms. Because increased prolactin can disrupt the reproductive system (hypogonadism), some of the signs and symptoms of prolactinoma are specific to women or men. In women, prolactinoma can cause:

• Irregular or spaced menstrual periods (oligomenorrhea) or lack of bleeding during menstruation in women of childbearing age (amenorrhea). Inappropriate growth of hair on the face and body (hirsutism)

In men, prolactinoma can cause the following disorders:

• Erectile dysfunction
• Decreased body and facial hair
• Breasts that are abnormally large (gynecomastia or breast enlargement) male).

Possible common symptoms of prolactinoma in both sexes are:

• Low bone density
• Decreased production of other hormones by the pituitary gland (hypophysis of the pituitary gland) as Result of tumor pressure Loss of interest in sexual activity Headache Visual disturbances Infertility Usually women notice the signs and symptoms of hyperprolactinemia earlier when the tumors are smaller. Probably because the irregularity of menstrual periods makes them aware earlier. Men notice signs and symptoms later, when the tumors are larger, and possibly because of headaches or vision problems.

  If someone has signs and symptoms associated with prolactinoma, they should see a doctor to find out the cause.

  Problems following high prolactin

  Symptoms of prolactinoma may include:

  • Vision loss, if the prolactinoma is If left untreated, the tumor may grow so large that it puts pressure on the optic nerve.
  • In cases where the prolactinoma is larger, the pressure on the normal pituitary gland may interfere with the secretion of other hormones that are under the control of the pituitary gland. which is called pituitary hypofunction or pituitary gland insufficiency and leads to hypothyroidism, adrenalin deficiency and growth hormone deficiency.
  • Bone loss (osteoporosis), high prolactin can reduce the production of estrogen and testosterone, which reduces bone density and increases the risk of osteoporosis. finds In a woman with prolactinoma, this high level of estrogen may cause tumor growth and associated signs and symptoms, such as headaches and vision changes.

  If you have prolactinoma and are trying to get pregnant or are pregnant, talk to your doctor about this. You may need treatment and monitoring settings.

  Diagnosis

  

  If there are signs and symptoms that indicate prolactinoma, the doctor may prescribe the following tests:

  • Blood test: Blood test It can detect overproduction of prolactin and whether the levels of other hormones controlled by the pituitary gland are within the normal range. A pregnancy test is also necessary for women who are of childbearing age. Brain imaging: A doctor may be able to diagnose a pituitary tumor from an image of the brain created by an MRI scan. Vision test: This test can determine whether a pituitary tumor has impaired vision. In addition, This, the doctor may refer the patient to a doctor specializing in the treatment of disorders of the endocrine system (endocrinologist) for further tests.

    Treatment of high prolactin

    Goals in the treatment of high prolactin are:

    • Restore prolactin production to normal levels
    • Restore the normal function of the pituitary gland
    • Reduce the size of the pituitary tumor
    • Remove complications or Symptoms of tumor pressure, such as headaches or vision problems
    • Improved quality of life

    There are two main treatments for prolactinoma: medication and surgery.

    Medications

    Oral medications can often reduce prolactin production and relieve symptoms. The size of the tumor may also shrink with the use of medicine. However, in drug treatment, it is generally necessary to have a long treatment period. Doctors use drugs called dopamine agonists to treat high prolactin. These drugs mimic the effects of dopamine (the brain chemical that normally controls prolactin production) but are much stronger and longer-lasting. Commonly prescribed medications include bromocriptine and cabergoline. These drugs reduce the production of prolactin, and in most people with prolactinoma, they may also reduce the size of the tumor.

    Drug use during pregnancy

    Bromocriptine is preferred for women who want to preserve their fertility. However, during pregnancy, the doctor recommends that both drugs be avoided. Although both drugs are safe in early pregnancy, their safety throughout pregnancy is still unknown. However, if someone has a large prolactinoma or develops signs and symptoms such as headaches or vision changes, the doctor may recommend that the drug be discontinued to prevent complications from the prolactinoma. If someone is being treated for the treatment of prolactinoma and wants to get pregnant, it is better to talk to your doctor before getting pregnant.

    Common side effects of drugs

    Nausea and vomiting, nasal congestion, headache and drowsiness are common side effects of these drugs. However, if the medication is started at very low doses, these side effects can often be minimized and the dose can then be gradually increased. Cabergoline is generally preferred over bromocriptine for treatment because it appears to be more effective than bromocriptine. Also, the side effects are less and milder. However, it is more expensive than bromocriptine, and since it is newer, its long-term safety profile is not yet well known. There are rare cases of heart damage with cabergoline, but these cases usually occur in people who take large amounts of the drug for Parkinson's disease. In some people, compulsive behaviors such as gambling may increase while taking these drugs. If the drug significantly reduces the size of the tumor and your prolactin levels remain normal for two years, you may be able to stop taking the drug with your doctor's advice. However, relapse is common. Do not stop taking the medicine without your doctor's approval.

    Radiation therapy

    For people who have not responded to medicine and are not a good option for surgery, radiation therapy can be an alternative method.

    Prolactin and foods

    Foods high in zinc regulate the body's metabolic activities. Also, zinc is very useful for prevention and treatment of premenstrual symptoms and syndrome, and it helps to eliminate menstrual disorders, which is one of the complications of this disease. Foods such as chicken, red meat, soybeans, green beans and peanuts are rich sources of zinc. Also, vitamin B5 can help improve this problem by maintaining the body's hormonal balance and helping zinc in metabolism. Foods such as brown rice, bran, cereals, carrots and spinach are sources of this vitamin. panel-widget-for-3360-0-1">

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