[Fat Bear Science] Sudden weight gain, acne, excessive hair growth, widening of teeth...? Please go to the neurosurgery or endocrinology department for treatment!

A 27-year-old man with a height of 1.91 meters grew 9 centimeters and gained 55 kilograms in 4 years;

A 40-year-old woman had a sudden and drastic decrease in vision;

A 28-year-old beauty is afraid to fall in love because she has been menopausal and lactating for 4 years;

…These are real cases that happened in Chongqing in recent years!!!

Although the symptoms seem completely different, they actually have a common "killer" behind them - pituitary tumor.

Lou Silong, deputy director and associate chief physician of the Department of Neurosurgery of our hospital, specially reminded through the Fat Bear Science Popularization Base that when the visual field becomes inexplicably smaller, the nose becomes wider, the gaps between teeth become larger, the fingers and toes become thicker, etc., you should be careful of pituitary tumors and it is best to go to the hospital's neurosurgery or endocrinology department for treatment in time.

Experts of this issue

Lou Silong

Lou Silong: Deputy Director and Associate Chief Physician of the Department of Neurosurgery, Chongqing Cancer Hospital, Young Member of the Neuro-Oncology Committee of the Chinese Anti-Cancer Association, has been engaged in clinical, teaching and scientific research work in neurosurgery for more than 10 years, with a solid theoretical foundation and rich clinical experience. He has considerable experience in nervous system tumors, complex craniocerebral trauma, functional neurosurgery, radioneurosurgery, etc. Clinic time: Thursday morning

Pituitary tumors are more common in women than in men

The pituitary gland is mainly composed of two parts, one is the posterior pituitary, also known as the adenohypophysis; the other is the anterior lobe, which is generally some neurohypophysis that secretes neurohormones. Pituitary tumors are benign tumors caused by abnormal proliferation of anterior pituitary cells, located in the sellar region, which is at the base of the brain and behind the eyeball.

In recent years, the incidence of pituitary tumors has tended to increase, ranking third among intracranial tumors after gliomas and meningiomas, accounting for approximately 10-15% of central nervous system tumors.

Moreover, according to epidemiological data from major medical centers in China, pituitary tumors can be seen in patients of any age, but there are two obvious peaks of incidence at 30-40 years old and 60-70 years old. In terms of gender, the incidence rate in women (especially premenopausal women) is significantly higher than that in men, which may be related to the fact that pituitary tumors can easily cause endocrine symptoms in female patients (such as menstrual disorders and lactation).

Symptoms of pituitary tumor patients vary

"In clinical practice, the symptoms of patients with pituitary tumors we have seen are very diverse." Director Lou pointed out that pituitary tumors have diverse clinical pathological types and different manifestations.

For example, depending on the size of the tumor, a tumor with a diameter of less than 25 mm is a pituitary microadenoma, and a tumor with a diameter of ≥25 mm is a pituitary adenoma.

According to the different secreted hormones, they can be divided into non-functional adenomas and functional adenomas. Among them, functional adenomas are divided into multiple subtypes according to the secreted hormone levels.

1. Prolactinoma, mostly female patients, mainly manifested as amenorrhea, lactation, infertility. Male patients mainly manifested as decreased male sexual function, such as decreased libido, impotence and infertility.

2. Growth hormone adenoma, the main manifestations are gigantism (occurring in adolescent patients with unclosed epiphyses), facial changes, enlarged hands and feet (increase in shoe size), hyperhidrosis, bone and joint lesions, carpal tunnel syndrome, swelling of the soft tissues and joints of the hands and feet, increased blood pressure, increased blood sugar, coronary heart disease, and tumors of the thyroid and colon, etc.

3. Adrenocorticotropic hormone-secreting pituitary tumor, the main manifestations are central obesity, moon face, acne, hirsutism, and purple striae (purple-red skin wrinkles on the body).

4. Thyrotropin-secreting pituitary tumors are mainly manifested by symptoms of high metabolism, such as heat intolerance, sweating, weight loss, palpitations and atrial fibrillation, etc.

Symptoms are not serious and the disease progresses slowly, so it is easy to be ignored

Director Lou told Fat Bear that because the early symptoms of most patients are not serious and the disease progresses slowly, the condition is easily overlooked.

Even if a functional adenoma is small, it can cause serious symptoms, such as amenorrhea, lactation, infertility, obesity, acromegaly, etc.

If it is a male, sexual dysfunction, infertility, etc. For non-functional adenomas, the early symptoms are hidden and there may be no symptoms. If the tumor further grows, symptoms of high intracranial pressure such as decreased vision, visual field defects, headaches, nausea, and vomiting may occur due to hydrocephalus.

Therefore, Director Lou reminds that the pathogenesis of pituitary tumors is unclear and cannot be prevented early. Therefore, when the visual field becomes inexplicably smaller, the nose becomes wider, the teeth become larger, and the fingers and toes become thicker, you must pay attention and go to the neurosurgery or endocrinology department of the hospital in time for early detection, early diagnosis, and early treatment.

Most of them are benign tumors, so don't worry.

"However, people don't have to worry too much. The vast majority of pituitary tumors are benign tumors. Pituitary cancer is rare and its incidence rate is very low, accounting for perhaps one in ten thousand pituitary tumors. Many doctors may never have seen one in their lifetime." Director Lou said that there are still a large number of people with benign pituitary tumors who live without clinical symptoms.

In autopsies abroad, a high percentage of people were found to have pituitary tumors but no symptoms. Some people have pituitary tumors, but if the tumors do not grow or are non-functional, they will not show symptoms.

The diagnosis of pituitary tumors is mainly based on corresponding clinical symptoms, signs, pituitary hormone testing and imaging examinations.

At present, the detection rate of pituitary tumors is still relatively high. Patients with corresponding symptoms should go to the corresponding department for examination. For example, if there is endocrine hormone disorder, they should see an endocrinologist. If an experienced doctor finds that the patient’s problem is not with the target organ, he can reversely infer that it is caused by a pituitary tumor.

Not all pituitary adenomas require surgery.

Director Lou introduced that the treatment of pituitary tumors includes minimally invasive surgery, craniotomy, drugs and radiotherapy. Currently, 95% of patients can undergo transsphenoidal minimally invasive surgery, while some patients need craniotomy or other comprehensive treatment plans, depending on the condition.

The doctor will develop an individualized treatment plan based on the size of the patient's pituitary tumor, hormone secretion, complications and comorbidities, the patient's age, whether there is a desire to have children, and the patient's financial situation.

Some functional adenomas require active surgical treatment, for example, because the patient's pituitary gland secretes too much hormones. For this type of pituitary adenoma, after surgical removal, the hormone levels in most patients can return to normal and the symptoms can be relieved.

However, not all pituitary adenomas require surgical treatment. For example, prolactinomas among functional pituitary adenomas now have effective drugs for treatment, so surgical treatment is generally not required.

In addition, non-functional pituitary adenomas with a diameter of less than 25 mm (i.e. pituitary microadenomas) do not need to be treated surgically in a rush. Instead, they can be followed up and observed through regular MRI examinations. If the non-functional microadenomas do not grow larger, surgery is not necessary.

Text/ Fat Bear Picture/ Online Reviewer/ Lou Silong

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