Pituitary Adenoma

What You Need to Know

  • 垂体腺瘤是垂体的良性肿瘤. 大多数位于腺体的前叶(前部).
  • 大约十分之一的人会在一生中患上垂体腺瘤.
  • 有些垂体腺瘤分泌过量的一种或多种激素. Even when they are small in size, 这些内分泌活跃的垂体瘤会导致荷尔蒙失衡,影响身体功能.
  • People can develop pituitary adenomas at any age.
切除腺瘤手术后的脑垂体MRI扫描.
Large pituitary adenoma after surgery seen in MRI

Pituitary Adenoma Symptoms

The symptoms of pituitary adenoma may include:

  • Headaches

  • Vision problems

  • Weight gain

  • Easy bleeding/bruising

  • 骨骼结构的变化,尤其是面部和手部

  • Menstrual irregularities

  • Lactation

  • Erectile dysfunction

  • Heat intolerance

MRI显示促肾上腺皮质激素(ACTH)分泌肿瘤

Types of Pituitary Adenomas

垂体腺瘤根据其大小和是否分泌激素进行分类.

Endocrine-Active Pituitary Tumors

大约50%的腺瘤产生过量的一种或多种特定激素. 这些内分泌活性肿瘤也被称为分泌性或功能性肿瘤. Excessive hormone secretion may cause: 

  • Cushing’s disease: Due to excessive corticosteroids in the body, 库欣综合征可引起多种症状, including:

    • Upper body obesity

    • Round face

    • 脖子周围的脂肪增加或肩膀之间的脂肪隆起

    • Thinning arms and legs

    • Fragile and thin skin

    • 腹部、大腿、臀部、手臂和乳房上的妊娠纹

    • Bone and muscle weakness

    • Severe fatigue

    • High blood pressure

    • High blood sugar

    • Irritability and anxiety

    • Excess facial and body hair growth in women

    • Irregular or stopped menstrual cycles in women

    • Reduced sex drive and fertility in men

产生生长激素的腺瘤,导致肢端肥大症
  • Acromegaly: 过度生长导致四肢、面部和软组织肿大. 肢端肥大症可能与高血压、糖尿病和心血管疾病有关. 肢端肥大症患者的预期寿命缩短.

  • Galactorrhea: 这种疾病的特点是乳腺分泌异常的乳汁.

  • Hyperprolactinemia

  • Reproductive problems, such as infertility

垂体左侧的泌乳素瘤

Prolactinoma 是一种过度分泌催乳素的垂体肿瘤吗. 催乳激素刺激乳房分泌乳汁. 垂体泌乳素腺瘤是最常见的垂体肿瘤类型, 约占所有垂体瘤的30%.

Endocrine-Inactive Pituitary Tumors

无内分泌活性的垂体瘤不会产生额外的激素. 它们也被称为无功能或无分泌垂体瘤.

术前垂体大腺瘤(正面)

Microadenoma and Macroadenoma

微腺瘤是直径小于10毫米(约四分之三英寸)的垂体腺瘤。. 直径大于或等于10mm的垂体腺瘤称为大腺瘤. 

Pituitary Adenoma Diagnosis

你的医生可能会使用血液检查、尿液检查和影像检查来诊断垂体腺瘤. 血液和尿液测试可以检测出诸如血浆催乳素(PRL)等激素的异常水平。, growth hormone (GH), insulin-like growth factor-1 (IGF-1), free thyroxine, cortisol, and testosterone. 某些激素的异常量可能表明一种特殊的垂体相关综合征.

Your physician may also use enhanced, 高分辨率MRI技术来识别垂体腺瘤的独特特征.

MRI显示术前较大垂体腺瘤
术前垂体大腺瘤(侧视图)

Pituitary Adenoma Treatment

腺瘤最有效的治疗方法是由包括神经外科医生在内的多学科团队协调, 耳鼻喉科医生和/或内分泌科医生(激素紊乱专家). 治疗可能包括观察的结合, medication (including hormone therapy), radiation therapy and surgery.

Observation

观察包括看神经外科医生或内分泌学家,他们可以开出定期的影像学检查计划来检查肿瘤的状态. 如果垂体瘤生长或症状恶化,你可能需要进一步治疗. 

Medication

药物(药物治疗)可以非常有效地治疗一些产生激素的垂体肿瘤. It may be used to:

  • Stop a tumor from producing excess hormones.  

  • 缩小肿瘤以阻止它压迫脑垂体或神经系统的其他部分.

  • 手术或放射治疗后治疗垂体瘤或控制激素.

  • 如果垂体瘤降低了身体产生必要激素的能力,或者手术后激素分泌过低(也称为激素替代疗法),则替代缺失的激素。.

Pituitary macroadenoma after surgery (front view)

Radiation Therapy

Radiation therapy for pituitary tumors includes external beam radiation therapy and stereotactic radiosurgery. 这些治疗可能需要几个月的时间来改善与垂体腺瘤有关的症状和状况.

放射治疗可能适用于下列垂体腺瘤:

  • 是否位于手术风险太大的大脑区域.

  • Cannot be completely removed during surgery.

  • Grow quickly.

  • Do no shrink with medication.

  • Recur after surgery.

有时放射治疗会导致脑垂体停止工作, even years after treatment. 在这种情况下,个人可能需要服用激素补充剂.

Pituitary macroadenoma after surgery (side view)

Surgery

手术切除垂体腺瘤很少需要 craniotomy,但更典型的是涉及一种称为手术的微创手术 endonasal endoscopic surgery 外科医生通过鼻子切除肿瘤. 重要的是要与一个知识渊博、有丰富垂体肿瘤手术经验的团队合作.

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