Pineocytomas & Pituitary Adenoma
A kind of non-cancerous tumors especially seen in adults that derive from the pineal cells are called Pineocytomas. They are non-invasive, slow-growing and homogeneous. In most cases they develop at the center of the brain. It can be removed successfully with the help of microsurgical techniques.
They are considered to be the most common intracranial tumors next to meningiomas, gliomas
and schwannomas. 10-15 % of all intracranial tumors are Pituitary Adenoma. Among the
pituitary adenomas, those smaller than 10 mm are called as microadenomas and those
exceeding 10 mm are macroadenomas.
Most of the Pituitary Adenomas are non-cancerous and slow-growing. Malignant pituitary adenomas are very rarely seen. Adenomas are considered to be the most common disease that affect the pituitary. They can be seen among children and more common among people in the age group of 30s-40s. Most cases can be successfully cured with appropriate treatment options.
Signs and symptoms
- In Children: Headaches, bumping in objects placed on sides, visual difficulties etc.
- In adult females: Visual difficulties, irregularities in the menstrual cycles.
- In adult males: Loss of sexual desire, visual difficulties.
Other general signs and symptoms may vary according to the type of adenoma. Some of them are:
- Nausea or vomiting
- Headaches in the forehead area
- Sexual dysfunction and infertility
- Muscle weakness
- Unexplained weight gain or weight loss
- Early menopause
- Depression, fatigue
- Pain in the joints, Osteoporosis
- Easy bruising
- Growth problems
- Carpal Tunnel Syndrome
It is better to treat pituitary adenoma as soon as possible. Surgery is considered to be the best option, if the patient doesn’t posses any other complications.
The Trans Nasal Endoscopic Surgery: It uses high definition optics and 4 hand techniques for the procedure. It is one of the best methods for removing the tumor completely with minimum chance for morbidity. Because of the following factors, this procedure is considered to be a best choice by most of the clinics and professionals:
- Less invasive
- Fewer side effects
- Faster recovery
The patient will be able to leave the hospital in two or four days after the surgery. The transcranial approach: It is chosen only when the Trans nasal approach fails to achieve the result as the tumor crosses the coronal plane.
Radiation therapy becomes the treatment method in cases where the surgery and medication have proved to ineffective to cure the tumor. It can also be choice if there is a small residual or recurrent tumor.
Stereotactic Radiosurgery (Gamma Knife and Cyberknife)
The procedure is a combination of external beam radiotherapy with a technique that focuses the radiation through many different ports. This procedure may evoke fewer damge to the tissues near to the pituitary gland.
Bromocriptine and cabergoline are the most prevalent agents used in medication therapy. Varied changes in the size of the tumors can be seen in most of the Prolactinoma patients with medication therapy. It can also:
- Improve the vision
- Restore menstrual cycle and fertility in women
- Resolve headache.
Bromocriptine can have side effects and moderate doses are usually prescribed. Cabergoline is a long-acting oral dopamine agonist which has recently been approved for hyperprolactinema by the Food and Drug Administration in U.S.A. It has fewer side effects when compared to that of Bromocriptine and can be taken twice in a week. It is more effective in patients whose prolactinomas are inresponsive to bromocriptine therapy.Authored By : DR. Manish Vaish
Dr Manish Vaish - Neurosurgeon
Neurosurgeon NCR, Delhi
Dr. Yashpal Bundela MS Mch
Dr.Girish Rajpal MS Mch FINR
Dr. Shiwani Jain MD FNB
PDFC (Neuro-anaesthesia and Critical care)
Dr Hrishikesh Chakrabartty
Dr.Praveen Kumar MS Mch
Dr. Manish Marda MD DM