Pituitary Adenoma: Conditions, Symptoms, Diagnosis, Treatment in Pune by Best Neurosurgeon in India

The symptoms of a pituitary adenoma depend on its size, whether it’s producing excess hormones, and if it’s pressing on surrounding structures. Symptoms can develop slowly over time, making diagnosis challenging. DrJaydev Panchwagh opines that common symptoms include:

Symptoms due to Pressure on Surrounding Structures (Mass Effect):

• Headaches: Often persistent and localized to the front of the head.
• Vision Problems: This is very common, particularly loss of peripheral (side) vision (bitemporal hemianopia), blurred vision, or double vision, caused by the tumor compressing the optic chiasm.
• Facial Numbness or Pain: Less common, if nerves are compressed.

Symptoms due to Hormonal Imbalances (Functioning Adenomas):

• Prolactinoma:
  • Women: Irregular or absent menstrual periods (amenorrhea), milky breast discharge (galactorrhea) unrelated to pregnancy or breastfeeding, infertility.
  • Men: Decreased libido, erectile dysfunction, reduced body hair, breast enlargement (gynecomastia), infertility.
• Growth Hormone (GH) Adenoma (Acromegaly in adults):
  • Enlargement of hands and feet (shoe and ring size increase).
  • Coarsening of facial features (enlarged nose, jaw, tongue).
  • Deepening of the voice.
  • Joint pain.
  • Sweating, skin thickening, and oiliness.
  • High blood sugar (diabetes).
• ACTH Adenoma (Cushing’s Disease):
  • Weight gain, especially in the face (moon face), neck, and abdomen.
  • Fat accumulation between the shoulders (buffalo hump).
  • Thinning skin that bruises easily.
  • Purple stretch marks (striae).
  • Muscle weakness.
  • High blood pressure, high blood sugar.
  • Mood changes, depression, irritability.
• TSH Adenoma:
  • Symptoms of hyperthyroidism: Weight loss, rapid heartbeat, nervousness, heat intolerance, tremor.
• Symptoms of Hormone Deficiency (if tumor compresses normal pituitary):
  • Fatigue, weakness, low blood pressure, nausea, weight loss, loss of appetite, low libido.

The exact cause of most pituitary adenomas is unknown. They are usually sporadic, meaning they develop without a clear hereditary reason. They are not linked to diet, environmental factors, or lifestyle.

However, a very small percentage of pituitary adenomas are associated with inherited genetic conditions, such as:

• Multiple Endocrine Neoplasia Type 1 (MEN1): A rare genetic disorder that can lead to tumors in multiple endocrine glands, including the pituitary, parathyroid, and pancreas.
• Familial Isolated Pituitary Adenoma (FIPA): A rare condition where only pituitary adenomas run in families.

Research continues to explore the genetic mutations that lead to these benign growths.

Accurate and comprehensive diagnosis is crucial for effectively managing pituitary adenomas, as their symptoms can mimic other conditions. Dr. Jaydev Panchwagh employs a multi-pronged diagnostic approach:

• Detailed Medical History and Physical Examination: A thorough review of your symptoms, especially vision changes and any signs of hormonal imbalance.
• Eye Examination (Visual Field Testing): Essential to detect any loss of peripheral vision, which is a key indicator of optic nerve compression.
• Blood and Urine Tests: These are vital to measure hormone levels (e.g., prolactin, growth hormone, cortisol, TSH, estrogen/testosterone). These tests help determine if the adenoma is functioning (producing excess hormones) and if the normal pituitary gland is being suppressed.
• Imaging Tests:
  • MRI (Magnetic Resonance Imaging) with contrast, of the Brain with special pituitary protocol: This is the gold standard for imaging pituitary adenomas. It provides highly detailed images of the pituitary gland and surrounding structures, allowing Dr. Panchwagh to precisely identify the tumor’s size, exact location, its relationship to the optic nerves, and its potential for extension into the skull base or sinuses.
  • CT Scan (Computed Tomography): May be used in some cases, particularly to assess bony structures of the skull base, though MRI offers superior soft tissue detail.

Combining these diagnostic findings allows Dr. Panchwagh to accurately characterize the pituitary adenoma and plan the most appropriate treatment strategy.

The treatment for a pituitary adenoma is highly individualized, depending on the type of adenoma (functioning or non-functioning), its size, whether it’s causing symptoms, and the patient’s overall health. Dr. Jaydev Panchwagh, with his specialized neurosurgical expertise, offers comprehensive treatment plans focused on effective tumor removal and symptom resolution.

1. Observation (Watchful Waiting):
   • For small, non-functioning adenomas that do not cause symptoms or vision problems, Dr. Panchwagh may recommend monitoring with regular MRI scans and visual field tests. This approach avoids unnecessary intervention if the tumor is stable.
2. Medication:
   • Primary Treatment for Prolactinomas: Medications called dopamine agonists (e.g., Cabergoline, Bromocriptine) are highly effective in shrinking prolactin-producing tumors and normalizing prolactin levels. For prolactinomas, medication is often the first-line treatment, sometimes avoiding surgery entirely.
   • For other Functioning Adenomas: Medications may be used to control hormone excess symptoms (e.g., somatostatin analogs for growth hormone adenomas) but typically do not shrink the tumor significantly and are often used as an adjunct to surgery or radiation.
3. Surgical Resection (Transsphenoidal Surgery):
   • The Gold Standard for Most Adenomas: Surgery is the primary treatment for most non-functioning pituitary adenomas and for many functioning adenomas (especially growth hormone, ACTH, and TSH-producing tumors) where medication is ineffective or not suitable.
   • How it Works (Transsphenoidal Approach): Dr. Jaydev Panchwagh performs this surgery, often using an Endoscopic or Microscopic Endonasal Approach. This minimally invasive technique involves accessing the pituitary gland through the nasal cavity and sphenoid sinus (an air-filled cavity behind the nose). There are no external incisions on the face, making it cosmetically superior and leading to faster recovery.
   • Benefits: This approach allows for direct access to the tumor while minimizing manipulation of the brain. It is highly effective for removing pituitary adenomas, relieving pressure on the optic nerves (improving vision), and normalizing hormone levels in functioning tumors.
   • Dr. Panchwagh’s Expertise: His training with Prof. Gaab (Germany) in Endoscopic Brain Surgery and Endoscopic Skull Base Surgery directly benefits patients undergoing transsphenoidal removal of pituitary tumors, allowing for safer and more complete removal with improved visualization. He has successfully removed giant pituitary tumors as well.
4. Radiation Therapy:
   • Purpose: Uses high-energy rays to destroy tumor cells or prevent their growth. It is usually considered as an adjunctive treatment:
     • After incomplete surgical removal: To treat any residual tumor and prevent recurrence.
     • As a primary treatment: For patients who are not surgical candidates or for tumors that do not respond to medication.

Types: Stereotactic Radiosurgery (SRS, like Gamma Knife or CyberKnife) delivers a highly focused dose of radiation in a single session for smaller tumors. Fractionated stereotactic radiotherapy delivers radiation in multiple smaller doses over several weeks.