Pituitary diseases are diseases with complex diagnosis and treatment protocols and require a multidisciplinary approach. It is a known fact that the success rate of the treatment is higher and the risks are lower when handled by teams specialized in this field.
Current diagnosis and treatments are appliedIn Liv Hospital Pituitary Center, patients are diagnosed and treated with the latest techniques and up-to-date protocols, and their quality of life is improved by questioning. In addition, educational meetings are held to inform patients and the society. Scientific contributions are also made by conducting scientific research and academic studies on pituitary tumors and diseases. Pituitary diseases, which can occur from the pediatric age group to the geriatric age group with a wide variety of complaints and clinical symptoms, can be followed and treated in the best way with a team specialized in their field.
Pituitary Diseases Followed and Treated by the Center:
- Patients with a mass in the pituitary gland in brain MRI taken for another reason
- Pituitary adenomas (benign anterior pituitary tumors)
- Hormone-secreting adenomas
- Cushing's Disease
These tumors are seen in young adults and older ages.
- Rathke sac cysts: They are congenital residual cysts. They are usually quiet.
- Craniopharyngiomas: It is seen especially in the pediatric age group and over 50 years of age.
- They are benign tumors that grow from congenital remains. However, due to the brain region they are in, their surgeries are high-risk and are considered among the most difficult operations for neurosurgeons.
- Other rare cysts and tumors
- Hypophysitis: It is rare. Most are autoimmune diseases.
- Pituitary hormone deficiencies (congenital or acquired)
Treatment is organized by the teamPituitary tumors are slow growing and chronic diseases. Some require lifelong follow-up. Metabolic effects can be very intense and complex, especially in hormone-secreting adenomas such as acromegaly and Cushing's disease. Some of the acromegaly may be familial. The diagnosis, differential diagnosis and treatment of these diseases should be organized with a team approach. The indispensable elements of the team are an endocrinologist experienced in the pituitary and a neurosurgeon experienced in pituitary surgery.
These diseases occur at varying rates according to age. However, it can be encountered at any age, from the pediatric age group to the geriatric age group. Therefore, a pediatric endocrinologist is needed for the pediatric group.
It can occur at any age, from pediatric to geriatric
It is possible for patients to receive the best service with a strong team. Other experts in the team are neuroradiologists, interventional neuroradiologists, neuroophthalmologists, neuroanesthesiologists and intensive care specialists, neuropathologists, ENT specialists, psychiatrists, psychologists and pituitary nurses.
Pituitary diseases are treated and monitored with very different protocols, depending on the diagnosis. Pituitary masses present with two groups of symptoms: If a hormone is secreted, special clinical pictures called the name of the secreted hormone are seen. If the hormone is not secreted, it usually gives symptoms later and symptoms due to the pressure it makes on the surrounding tissues.
May not show early symptoms
Compression symptoms that their masses can cause
- Decreased visual acuity
- visual field loss,
- One-sided drooping of the eyelid,
- Atypical pain, numbness in one half of the face,
- Inward or outward strabismus
Symptoms of prolactinoma:
- Menstrual irregularities/absence of menstruation
- Milk coming from the breasts
- Tightness/pain in the breasts
- inability to get pregnant
- Loss of sexual desire
- Sexual aversion and weakness
- enlargement of the breasts
Symptoms of acromegalyBefore puberty:
- Having a very long neck for age and gender (giantness)
- Coarse facial features,
- Forward growth / elongation of the nose and chin,
- Nasal congestion, difficulty breathing (concha hypertrophy)
- spacing of teeth,
- Inability of the jaw to close normally,
- language growth,
- Sleep apnea,
- Enlarged hands (narrow rings)
- enlargement of the feet (increasing the size of the shoes),
- Trap neuropathies (nerve compression),
- Calcifications in the spine,
- Heart disease,
- Secondary malignancy such as colon/thyroid/breast cancer
Symptoms of Cushing's disease
- Weight gain, inability to lose weight
- Facial swelling, rounding, redness
- Oily skin, acne
- easy bruising on the skin
- hair growth
- Subcutaneous swellings on the back of the neck, on the sides of the neck
- purple cracks
- Hair thinning, shedding
- muscle weakness,
- Muscle pains
- Heart disease
Symptoms of thyrotropinoma (Symptoms of Hyperthyroidism)
- Inability to stand the heat,
- shaking hands
- Weight loss.
Symptoms of gonadotropinoma:It has no special symptoms. Pressure symptoms can be seen. Symptoms of adenomas that do not secrete hormones: Pressure symptoms may be seen.
Patients who are thought to have a pituitary tumor with these symptoms should consult an endocrinologist. The endocrinologist performs a series of blood and urine tests and requests radiological examinations to diagnose the disease. It can sometimes take time to confirm the diagnosis. After the diagnosis is made, a treatment plan is made by discussing in the pituitary council. Treatment of prolactinomas begins with drug therapy. In 95% of patients, the drug is sufficient to treat the disease.
Treatment is discussed at the pituitary council
Some patients may develop intolerance or resistance to the drug. The main treatment for acromegaly and Cushing's diseases is surgery. The main treatment for rare TSH-secreting tumors is surgery. Tumors smaller than 1 cm (microadenoma) that do not secrete hormones can be observed. In macroadenomas, the decision is made by considering the compression symptoms and the patient's age, comorbidities, and surgical risks.
How is the treatment done?
- Random pituitary masses smaller than 1 cm are followed at regular intervals if they do not secrete endocrine hormones. If it is larger than 1 cm, it is usually a candidate for surgical treatment. Of the hormone-secreting pituitary tumors, only prolactinomas are followed up first by starting drug therapy. All other hormone-secreting masses, regardless of their size, are candidates for surgical treatment.
- Rathke sac cysts are only observed as long as they do not cause symptoms.
- Treatment of craniopharyngiomas is pituitary surgery.
- If the diagnosis is clinically definite in hypophysitis, it is followed up with medical treatment. Biopsy can be taken with transsphenoidal surgery if necessary for diagnosis.
- Cushing's and acromegaly patients are called for life-long annual polyclinic control after surgery, especially since late recurrences may occur.
- Acromegaly and cushing's patients who have not achieved remission (well-being / hormonal reduction to the desired level) with surgery are followed up with medical treatment. In those who are not in remission, pituitary surgery and radiotherapy for the second time may be considered as third-line treatment.