Liv Hospital Vadistanbul

Pituitary Center

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 applied

In 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
  • acromegaly
  • Cushing's Disease
  • prolactinoma
  • Thyrotropinoma
  • Gonadotropinoma

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 team

Pituitary 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.

It can occur at any age, from pediatric to geriatric

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 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.

May not show early symptoms

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.

Compression symptoms that their masses can cause

  • Headache,
  • Weakness,
  • 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 due to the excess of the hormones they secrete: A clinical picture depending on the excess of the hormone appears. These should also be considered.

Symptoms of prolactinoma:

In women:
  • Menstrual irregularities/absence of menstruation
  • Milk coming from the breasts
  • Tightness/pain in the breasts
  • inability to get pregnant
  • Loss of sexual desire
In men:
  • Sexual aversion and weakness
  • enlargement of the breasts
  • infertility

Symptoms of acromegaly

Before puberty:
  • Having a very long neck for age and gender (giantness)
After puberty:
  • 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,
  • Snore,
  • Sleep apnea,
  • Enlarged hands (narrow rings)
  • enlargement of the feet (increasing the size of the shoes),
  • Trap neuropathies (nerve compression),
  • Calcifications in the spine,
  • Hypertension,
  • diabetes,
  • 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
  • osteoporosis
  • Depression
  • Hypertension
  • diabetes
  • Heart disease

Symptoms of thyrotropinoma (Symptoms of Hyperthyroidism)

  • Sweating,
  • Inability to stand the heat,
  • Palpitation,
  • 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.

Treatment is discussed at the pituitary council

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.
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.

What is transsphenoidal surgery?

The pituitary gland is located under the brain, in a bony socket at the base of the skull. It is located in the middle of our head from right to left, from top to bottom, and from front to back. There are many methods to reach here and remove the tumor, but the most preferred method is the "transsphenoidal" method, which is reached from the skull base. Transsphenoidal surgery, which has been known and applied for over a century, is a safer and lower risk surgery since the skull will not be opened and the brain will not be touched. In addition, the patient does not have any surgical incision marks.

Microscopic surgery for large tumors

In recent years, transsphenoidal pituitary surgery with the endoscopic method has come to the fore. In this method, which is used through the nostrils with endoscope and surgical instruments, the skull base can be seen more widely, and after the tumor is evacuated, the endoscope can be advanced into the tumor to examine whether there is any residue around it. It is preferred to microscopic surgery, especially since it provides a higher rate of success in the treatment of large tumors.

What are the necessary preparations before transsphenoidal surgery?

There should be no infection in the upper respiratory tract. Anticoagulant drugs should be discontinued at least 1 week before (However, the drug should be discontinued under the supervision of a doctor, and other drugs should be given instead if necessary). Anesthesia examination should be done a few days in advance.

What is the chance of success in the treatment of the disease with pituitary surgery?

Although it varies according to the characteristics of the tumor, the technical equipment of the hospital and the experience of the surgeon, the success rate is between 60-90%.

What are the risks of pituitary surgery?

The risk is low in centers where this surgery is performed frequently. The most common risk is excessive drinking and urination (diabetes insipid). It is a temporary complication that usually resolves within a few days. It is easy to control with medication. The emergence of a new deficiency in pituitary hormones is the second possible complication. Complications such as great vessel injury, neural tissue injury, cerebrospinal water (CSF) leakage, and meningitis may rarely be encountered. The risk of death due to surgery is around 0.1%. Generally, 2-4 days of hospitalization is sufficient after surgery. Tumors larger than 4 cm are called giant adenomas. These tumors are much more difficult to treat. The complication rate is higher. Longer hospital stay and transcranial second surgery may be required.

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