Pituitary adenomas are tumors that occur in the pituitary gland, and account for about 15% of intracranial neoplasms. They often remain undiagnosed, and small pituitary tumors have an estimated prevalence of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies).
Pituitary tumors were, historically, classed as basophilic, acidophilic, or chromophobic on the basis of whether or not they took up the stains hematoxylin and eosin. This classification has fallen into disuse, in favor of a classification based on what type of hormone is secreted by the tumor (though tumors which do not secrete any active hormone (“non-functioning tumors”) are still sometimes called “chromophobic”).
The diagnosis is generally entertained either on the basis of visual difficulties arising from the compression of the optic nerve by the tumor, or on the basis of manifestations of excess hormone secretion: the specifics depend on the type of hormone. The specific area of the visual pathway at which compression by these tumours occurs is at the optic chiasma.
The anatomy of this structure causes pressure on it to produce a defect in the temporal visual field on both sides, a condition called bitemporal hemianopia. Lateral expansion of a pituitary adenoma can also compress the abducens nerve, causing a lateral rectus palsy.
Tumors which cause visual difficulty are likely to be macroadenoma greater than 10 mm in diameter; tumors less than 10 mm are microadenoma.
Some tumors secrete more than one hormone, the most common combination being GH and prolactin.
Prolactinomas are frequently diagnosed during pregnancy, when the hormone progesterone increases the tumor’s growth rate. Headaches may be present. Women and men can both present with decreased libido. The diagnosis is confirmed by testing hormone levels, and by radiographic imaging of the pituitary (for example, by CT scan or MRI).
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