Pituitary adenoma
Introduction
Introduction to pituitary adenoma Pituitaryadenoma is a benign adenoma, which is quite common. There are 1 out of about 100,000 people. In recent years, there has been an increasing trend, especially for women of childbearing age. Beijing Institute of Neurosurgery reported that pituitary tumors accounted for 12.2% of intracranial tumors. The pituitary gland is located in the saddle socket of the skull base, which is a saddle septum, which is separated from the ventricle and the bottom of the third ventricle. The pituitary stalk passes through the saddle septum and connects the hypothalamus and the pituitary. The pituitary stalk is composed of blood vessels and nerves. Both sides of the pituitary are venous cavernous sinus. There are internal carotid artery, oculomotor nerve, trochlear nerve, abductor nerve and trigeminal nerve. One passed. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: hemiplegia aphasia
Cause
Cause of pituitary adenoma
The cause is unclear, and the possible causes are: genetic factors, physical and chemical factors, and biological factors.
Prevention
Pituitary adenoma prevention
Prevention of infection, symptomatic treatment, complications for the treatment of complications, correction of cerebral edema, reduction of intracranial pressure with 20% mannitol, furosemide, dexamethasone as the main drug, even human albumin, pay attention to electrolytes and Body fluid balance, intraoperative supplementation of blood loss.
Complication
Pituitary adenoma complications Complications hemiplegia aphasia
Tumors may have hemiplegia, aphasia, polydipsia, polydipsia, polyuria and other complications to neighboring growth oppressors.
Symptom
Pituitary adenoma symptoms Common symptoms Meningeal irritation Symptoms Defects Urinary disintegration Limbs excessive hypertrophy Postpartum pituitary necrosis Breast and genital atrophy
It is related to the patient's gender, age, tumor size and direction of expansion, and the type of hormone secreted, including the following four groups of symptoms:
1 symptoms and signs caused by excessive secretion of hormones in pituitary tumors, common in acromegaly, Cushing's disease and prolactinoma;
2 pituitary body compression group, mainly the pituitary hormone secretion reduction, generally affect the growth hormone GH first, followed by luteinizing hormone, follicle stimulating hormone, and finally adrenocorticotropic hormone, thyrotropin, a small number may be associated with diabetes insipidus;
3 tissue surrounding the pituitary gland, including headache, decreased vision, visual field defects, hypothalamic syndrome, cavernous sinus syndrome and cerebrospinal fluid rhinorrhea;
4 pituitary apoplexy, refers to pituitary adenoma and / or pituitary itself infarction, necrosis or hemorrhage, clinically rapid compression symptoms and meningeal irritation, clinical manifestations of pituitary hyperfunction can disappear or reduce, and even hypopituitar dysfunction .
Examine
Examination of pituitary adenoma
1. Endocrine examination
Direct measurement of pituitary growth hormone, prolactin, adrenocorticotropic hormone, thyroid stimulating hormone, melanin stimulating hormone, follicle stimulating hormone, luteinizing hormone, etc. by endocrine radioimmunoassay, which has a very early diagnosis of pituitary adenoma Great help.
2. Radiological examination
(1) Sella image: As one of the basic examinations, the saddle can be unchanged in the small pituitary tumor. As the tumor grows, it can cause the saddle to enlarge, bone destruction, saddle erosion and so on.
(2) CT scan: After enhancement with intravenous contrast agent, it can show pituitary adenoma of 5 mm size, and smaller tumors still show difficulty.
Diagnosis
Diagnosis and diagnosis of pituitary adenoma
diagnosis
The diagnosis of pituitary tumors is mainly based on the patient's clinical manifestations, vision visual field disorders and other neurological findings, as well as endocrine and radiological examinations. Typical pituitary tumor diagnosis is not difficult, but in early pituitary tumors, symptoms are not very good. Obviously, the diagnosis is not easy or even impossible to find.
Differential diagnosis
(1) craniopharyngioma: occurs mostly in children and young people, with slow onset, in addition to visual and visual impairment, as well as developmental stagnation, sexual organ dysplasia, decreased pituitary function such as obesity and diabetes collapse, and involvement of the hypothalamus. Large-volume tumors have symptoms of increased intracranial pressure. In most cases, the tumor has cystic changes, calcification, multiple tumors on the saddle, and pituitary tissue at the bottom of the saddle.
(2) Saddle nodule meningioma: mostly in middle-aged people, the disease progresses slowly, the initial symptoms are progressive vision loss with irregular visual field deficiency, headache, endocrine symptoms are not obvious, imaging tumor morphology rules The enhancement effect is obvious, the tumor is located on the saddle, and the pituitary tissue is in the saddle bottom.
(3) Raske's fissure cyst: young age, no obvious clinical manifestations, a small number of endocrine disorders and vision loss, radiographic findings, small cysts located between the anterior and posterior pituitary, similar to the "three-name" pie . Large cysts of the pituitary tissue are pushed to the underside of the cyst, anterior and superior, and the disease is most easily misdiagnosed as pituitary tumor.
(4) Germ cell tumor: also known as ectopic pineal tumor, mostly in children, rapid development of disease, polydipsia, precocious puberty, weight loss, clinical symptoms, imaging lesions are mostly located in the saddle, enhancing effect obvious.
(5) Optic glioma: occurs mostly in children and young people. It is mainly caused by headache and vision loss. The imaging lesions are mostly located on the saddle, and the boundary of the lesion is unclear. It is a mixed signal and the enhancement effect is not obvious.
(6) Epithelioid cysts: more common in young people, slow onset, visual impairment, imaging findings of low-signal lesions.
