Pituitary tumors shows abnormal growths which arise in the pituitary gland. It is a tiny organ the size of a pea situated near the base of the brain. By releasing hormones that regulate growth, metabolism, reproduction, and other vital processes, this gland contributes significantly to the regulation of numerous body functions. 

The hormone which is responsible in milk production in women called prolactin. This is produced in excess amount by these tumors. Infertility problems, abnormal menstruation cycles, and breast milk production in non-nursing individuals are among the possible symptoms. 

According to studies around 10% and 15% of all cerebral tumors are pituitary tumors. Pituitary tumors are rather prevalent. 

According to autopsy studies, up to 25% of some populations may have an even higher frequency of pituitary tumors. It is considered as there is 1 case of pituitary tumor for every 100,000 people. 

Mutations in certain genes, such as those linked to familial diseases like Carney complex and multiple endocrine neoplasia type 1. 

Growth hormone-secreting tumors that raise the level of growth hormone, which is depending on the age at which they first appear, might cause gigantism or acromegaly. 

Gene mutations affecting apoptosis, DNA repair processes, and cell cycle progression might cause this uncontrollable cell proliferation. 

There is no obvious hereditary tendency for the spontaneous occurrence of many pituitary tumors. The formation of these tumors may be aided by sporadic mutations in certain genes, such as those regulating the cell cycle, suppressing tumor growth, and signaling hormone pathways. 

The hypothalamic-pituitary axis regulates hormones which are responsible for production and release as well as abnormality in this system is crucial in the creation of pituitary tumors. 

The specific type of pituitary tumor and its size are significant prognostic factors. the tumors like Prolactinomas, growth hormone-secreting tumors, and ACTH-secreting tumors all are functioning tumors as may have different prognoses based on their hormonal activity and associated symptoms. 

Histological characteristics of pituitary tumors, including cell type, proliferation index, and presence of atypical features, can provide valuable prognostic information.  

Age Group:  

While pituitary tumors are relatively rare in children, they can still occur. In paediatric populations, the most common type of pituitary tumor is often a prolactinoma, which may present with symptoms such as delayed puberty, growth delay, or visual disturbances. 

Pituitary tumors can also affect young adults, typically between the ages of 20 and 40 years.

Associated Comorbidity or Activity:   

Pituitary tumors, particularly functioning tumors, can lead to hormonal imbalances by overproducing or underproducing certain hormones. 

Growth hormone-secreting tumors can result in acromegaly or gigantism, causing enlargement of bones and soft tissues, hypertension, diabetes, and cardiovascular complications.  

Pituitary tumors can compress nearby structures, such as the optic nerves and chiasm, leading to visual disturbances. 

Pituitary tumors, especially larger ones, can cause headaches due to increased intracranial pressure or compression of surrounding structures.  

Certain pituitary tumors, particularly those that secrete excessive antidiuretic hormone (ADH), can lead to hyponatremia by causing the body to retain water excessively.  

Acuity of Presentation:  

Pituitary apoplexy is a medical emergency characterized by sudden hemorrhage or infarction within a pituitary tumor. This can result in severe headache, vision loss, altered mental status, nausea, vomiting, and hormonal deficiencies. 

Large pituitary tumors or those with rapid growth can compress the optic nerves or chiasm, leading to acute visual disturbances or even sudden vision loss. 

• Ophthalmologic examination: Evaluation by an ophthalmologist may reveal signs of optic nerve compression, such as optic disc edema, decreased visual acuity, or abnormalities in pupillary responses. 
• Cranial nerve examination: Pituitary tumors can compress adjacent cranial nerves, leading to deficits such as diplopia due to involvement of the abducens nerve, or facial numbness or weakness due to involvement of the trigeminal nerve. 
• Endocrine examination: Assessment of endocrine function may reveal signs of hormonal imbalances associated with functioning pituitary tumors.  

• Transsphenoidal surgery: The primary treatment for most pituitary tumors is transsphenoidal surgery, which involves removing the tumor through the nasal cavity and sphenoid sinus without the need for a craniotomy. 
• Endoscopic surgery: Endoscopic techniques have become increasingly popular for transsphenoidal pituitary surgery, offering improved visualization and access compared to traditional microscopic approaches. 
• Radiation Therapy: External beam radiation therapy (EBRT) may be considered for residual or recurrent pituitary tumors that are not amenable to surgery or for patients who are not surgical candidates.  

Neurology

Neurosurgery

• Stress reduction: Chronic stress can exacerbate symptoms associated with pituitary tumors, particularly those related to hormonal imbalances such as Cushing’s disease. 
• Healthy lifestyle habits: Encouraging patients to adopt healthy lifestyle habits such as regular exercise, balanced nutrition, adequate sleep, and stress management can contribute to overall health and well-being.  
• Medication adherence: For patients receiving medical therapy for pituitary tumors, ensuring adherence to prescribed medications is essential for achieving optimal treatment outcomes.

Internal Medicine

Neurology

• Bromocriptine: Bromocriptine is a dopamine agonist used primarily in the treatment of prolactinomas. It acts by inhibiting prolactin secretion from the tumor cells, thereby reducing tumor size and alleviating symptoms such as galactorrhea, amenorrhea, and infertility. 

Internal Medicine

Neurology

• Octreotide: Octreotide is a somatostatin analogue that is used in the treatment of growth hormone-secreting pituitary tumors (acromegaly). It acts by inhibiting growth hormone secretion and reducing tumor size. Long-acting formulations of octreotide are available for once-monthly administration. 

Internal Medicine

Neurology

• Ketoconazole: Ketoconazole is an antifungal medication with glucocorticoid receptor antagonist activity. It is sometimes used as a medical therapy for Cushing’s disease, inhibiting cortisol synthesis and reducing the symptoms associated with excess cortisol production. 
• Metyrapone: Metyrapone is another medication used in the medical management of Cushing’s disease. It inhibits cortisol synthesis by blocking the activity of 11-beta hydroxylase enzyme, leading to a decrease in cortisol levels. 

Internal Medicine

Neurology

• Estrogen: This includes a blend of estrogens that are only found in natural sources. These estrogens are formed by combining sodium salts of water-soluble estrogen sulfates to create a substance that is representative of the average composition of urine from pregnant mares. 

Neurology

Neurosurgery

• Transsphenoidal Surgery:  The sphenoid sinus is opened to create a pathway to the sella turcica, the bony cavity containing the pituitary gland. Using specialized instruments and microscopes or endoscopes for visualization, the surgeon carefully removes the tumor from the pituitary gland.  

Neurology

• Preoperative Phase: This phase begins with the evaluation of patients presenting with symptoms suggestive of pituitary tumors, such as hormonal imbalances, visual disturbances, or neurological symptoms.  
• Surgical Phase: For patients undergoing surgical resection of pituitary tumors, the surgical phase involves preoperative preparation, the surgical procedure itself, and postoperative care. 
• Rehabilitation Phase: Patients with pituitary tumors may experience hormonal deficiencies following surgery or because of tumor-related damage to the pituitary gland.