What is Pituitary Macroadenoma?
Pituitary Macroadenoma is a variant of adenomas or benign and noncancerous tumors formed in the pituitary gland. Basically, there are two forms of Pituitary Adenoma of which one is less than 10 mm in size and is called as Pituitary Microadenoma whereas the growths or tumors which are greater than 10 mm are called as Pituitary Macroadenoma.
The pituitary gland is a bean shaped organ found in the base of the brain. This gland plays a vital role in regulation of blood pressure and functioning of other important organs of the body. Pituitary Macroadenoma is a benign condition and does not affect the function of the gland in any way in majority of the cases but in some cases these tumors may cause certain symptoms like headaches.
The front line treatment for Pituitary Macroadenoma is surgery. There are various approaches depending on the location and sizes of the tumor for treatment of Pituitary Macroadenoma.
Studies have shown that if an individual has a family history of this condition then the chances of that individual is higher than the normal population of developing Pituitary Macroadenoma.
What are the Causes of Pituitary Macroadenoma?
The root cause of Pituitary Macroadenoma is not yet known. Anatomically speaking, the pituitary gland is located in the base of the brain somewhere between the ears. Even though this gland is of a very small size, it plays a vital role in functioning of various important organs of the body.
The pituitary gland influences and regulates blood pressure, reproduction, and growth of the body. Usually, the functioning of the gland is not significantly impaired in majority of the cases by the presence of Pituitary Macroadenoma.
What are the Symptoms of Pituitary Macroadenoma?
Pituitary macroadenoma can be the reason behind development of various medical conditions like Cushing’s syndrome, acromegaly, hyperthyroidism and in rare cases symptoms related to reduced secretion from the pituitary gland. Some of the symptoms of Pituitary Macroadenoma include:
- Frequent headaches
- Vision problems
- Persistent dizziness
- Unexplained growth or loss of hairs
- Unintentional weight changes
- Menstrual period changes in females
- Erectile dysfunction in males.
How is Pituitary Macroadenoma Diagnosed?
The diagnosis of Pituitary Macroadenoma may be suspected based on the symptoms exhibited by the patient. If Pituitary Macroadenoma is suspected, the physician may do a battery of tests to confirm the diagnosis. These tests include blood tests, urinalysis, and tests to check the visual field.
Additionally, the physician may order advanced imaging studies to include CT and MRI scans of the brain which will clearly show the presence of lesion within the pituitary gland confirming the diagnosis of Pituitary Macroadenoma.
How is Pituitary Macroadenoma Treated?
Surgery is the front line treatment for Pituitary Macroadenoma. There are several modes of surgical removal of Pituitary Macroadenoma.
Transsphenoidal Approach: The most preferred surgical approach for Pituitary Macroadenoma is called as transsphenoidal approach towards removal of a Pituitary Macroadenoma.
During the surgical procedure, the surgeon will create an incision within the sphenoid bone to gain access to the sphenoid sinus. Another incision will be made to create a hole within the sella turcica which is the bone that protects the pituitary gland.
Once access is gained to the pituitary gland, the tumor will be visualized and once confirmed the removal of tumor will take place. Post removal of the tumor, the surgeon will seal the cavity caused by the tumor.
This may be the most preferred treatment for Pituitary Macroadenoma but there are other approaches towards treatment as well. Microsurgery is a type of surgery which utilizes powerful microscopes to distinguish between the small structures in and around the pituitary gland.
Endoscopic surgery is yet another form of surgery which is normally done to break the tumor into small pieces and then remove them completely. These are both minimally invasive surgeries and there is very little if any chance of trauma surrounding the pituitary region thus allowing for a faster recovery postprocedure. In majority of the cases, the patient is able to return home within two days of the procedure for treating Pituitary Macroadenoma.
Gamma Knife Radiosurgery: This is the most novel form of treatment for Pituitary Macroadenoma. It achieves similar results that are achieved with the traditional form of surgery for treating Pituitary Macroadenoma.
The main disadvantage with the Gamma Knife surgery is that it takes many years for the abnormal hormone levels caused by the Pituitary Macroadenoma to normalize and requires constant monitoring which is not the case with the traditional surgeries
In this procedure, many small beams of radiation are directed towards the tumor. All these beams converge at the tumor and break them into small pieces. This is an outpatient procedure and the patient can go home the same day.
Medications: Medications are required to be utilized to bring the hormone levels back down to normal which tend to increase as a result of Pituitary Macroadenoma.
- Mayo Clinic. (2021). Pituitary tumors. https://www.mayoclinic.org/diseases-conditions/pituitary-tumors/symptoms-causes/syc-20351868
- Cohen, A. R. (2017). Pituitary tumors: overview of diagnosis and management. Neurosurgery Clinics, 28(3), 341-347. https://doi.org/10.1016/j.nec.2017.02.006
- Freda, P. U., & Beckers, A. M. (2019). Primary treatment of acromegaly: surgery, somatostatin analogs, or GH receptor antagonists. The Journal of Clinical Endocrinology & Metabolism, 104(1), 1-7. https://doi.org/10.1210/jc.2018-01042
- Melmed, S. (2017). Pituitary-tumor endocrinopathies. New England Journal of Medicine, 376(13), 1251-1262. https://doi.org/10.1056/NEJMra1510057