Clinical manifestations of hormonally-active pituitary adenomas are composed of endocrine-exchange syndrome ophthalmia neurological and radiological symptoms. Severity of endocrine-exchange syndrome reflects the level of excess pituitary hormone and the extent of damage to tissue surrounding the tumor. At some pituitary adenomas, such as cortico tropinomah, some tireotropinomah, the clinical picture is due not so much excessive elaboration of the tropic hormones as related activation of the target organ, expressed hypercortisolism, hyperthyroidism.
Ophthalmia neurological symptoms indicating the presence of pituitary adenoma (primary optic atrophy, changes in the field of view by type bitemporal hemianopsia, gipopsii, etc.) depend on suprasellyarnogo tumor growth, while due to the pressure of the tumor on the diaphragm sella a headache, localized in the frontal, temporal lobe, behind the orbital areas are usually dull, not accompanied by nausea, independent of body position and not always removable analgesics. Further growth of the tumor up leads to damage of hypothalamic structures. The growth of pituitary adenoma in a lateral direction causes compression of III, IV, VI and V branches of cranial nerves with the development of ophthalmoplegia and diplopia. Tumor growth downwards, towards the bottom of the sella, and distribution process in the sphenoid sinus, ethmoid sinuses may be accompanied by a feeling of nasal congestion and the expiration of nasal cerebrospinal fluid (liquorrhea).
The sudden intensification of headache and neurological symptoms ophthalmia in patients with pituitary adenoma associated most often with either an acceleration of tumor growth, such as during pregnancy or with hemorrhage into the tumor. Hemorrhage into the tumor considered serious but not fatal complications. Established that the hemorrhage in pituitary adenomas occur quite frequently and can lead, in addition to strengthening the headache, visual impairment and the development of hypopituitarism, the spontaneous cure of hormone-active pituitary adenomas. Spontaneous healing inherent in most prolactinomas. Increased tumor during pregnancy, possibly due to the inevitable increase in the adenohypophysis during this period, noted that most patients with prolactinomas after delivery swelling decreases.
Symptoms of pituitary adenoma, as identified by X-ray examination, are changing the shape and dimensions of sella, thinning and destruction of bony structures that form it, and so CT can be visualized and the tumor itself.
For certain hormonally-active pituitary adenomas characterized by specific clinical symptoms. Prolactinoma in women appear syndrome galaktorei amenorrhea. Often, the main endocrine manifestation of these tumors is only galactorrhea or only irregular menstruation, or infertility, but most say the combination of these symptoms. About a third of women with prolactinomas observed moderate obesity, mild pronounced hypertrichosis, acne, seborrhea of the scalp, disturbance of sexual function decreased libido, anorgasmia, etc. For men the main endocrine manifestations of prolactinoma are disorders of sexual function (decreased libido, impotence), gynecomastia and Galactorrhea is relatively rare. In women with prolactinomas to the detection of tumor Ophthalmia neurological violations do not occur in more than 26% of cases, men have dominated Ophthalmia neurological symptoms. This is due, apparently, so that women prolactinoma is detected more frequently at the stage of microadenomas, and men due to the slow growth of non-specific symptoms such as impotence, etc., almost always reveal the tumor is already large.
Somatotropinomy clinically acromegaly or gigantism syndrome in children. When acromegaly in addition to typical changes in the disease of the skeleton and soft tissues may be increased, to develop obesity and symptoms of diabetes, is often observed enlargement of the thyroid gland (often with no dysfunction). Often mark the hirsutism, the appearance of warts, nevi, warts on the skin, expressed by the greasiness of the skin, increased sweating, decreased availability of patients. Oftalmonevrologicheskaya symptoms at somatotropinomah develops at some stage during ekstrasellyarnom tumor growth. In addition to the above symptoms noted peripheral polyneuropathy, manifested paresthesias, decreased sensitivity in the distal extremities, pain in the limbs.
Kortikotropinomy are rarely encountered pituitary adenomas. Current data in Cushing's disease Itsenko kortikotropinomy detected in almost 100% of cases. The progressive increase in corticotropin after bilateral adrenalectomy. produced about illness Itsenko Cushing's syndrome is called Nelson. Kortikotropinomy more often than other types of pituitary adenoma may be malignant and metastasize. Endocrine syndrome in kortikotropinomah exchange due to both the manifestations of hypercortisolism typical of Cushing's disease Itsenko and hyperproduction of ACTH and of related peptides b-lipotropic factor pituitary melanocyto-stimulating hormone with increased skin pigmentation. Ophthalmia neurological symptoms at kortikotropinome usually not detected because these tumors that cause severe endocrine disorders are diagnosed, usually sooner. For corticotropin typical endocrine mental disorders.
Gonadotropinomy and tireotropinomy are also rarely encountered pituitary adenomas. Their endocrine and metabolic manifestations depend on whether these are primary tumors, or they evolved as a result of long-existing lesions cancer target (eg, hypogonadism, or hypothyroidism). Primary tireotropinomy cause the development of hyperthyroidism, secondary detected against the background of hypothyroidism. When gonadotropinomah note gilogonadizm rarely galaktoreyu by concomitant hypersecretion of prolactin adenohypophyseal tissue surrounding the tumor. Gonadotropinomy usually diagnosed on the basis of ophthalmia neurological symptoms, because Endocrine manifestations of these tumors are nonspecific.
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