Prolactinoma of the pituitary: causes, symptoms, diagnosis and treatment. What is the pituitary gland responsible for?

When a person sees a complex medical term, he begins to disassemble it into components in order to understand his illness. Therefore, his first question to himself will be: "What is the hypophysis responsible for?". After a thorough search for information, he will find out that this is a gland of internal secretion, which regulates the work of all other glands in the body. Further research will lead the patient to the list of hormones and target organs that he produces. And only after that he will decide, finally, to find out what the phrase "prolactinoma of the pituitary gland" means. It is a tumor that produces too much hormone, so that the body can cope with them. Excess prolactin and causes characteristic clinical symptoms. But first things first.

What is the pituitary gland?

What is the pituitary gland responsible for? The pituitary gland is part of the midbrain, located on the basal surface of it, in the bone formation called the "Turkish saddle". This gland produces hormones that regulate human growth, metabolic rate and reproduction of offspring. Gipofiz - the conductor of the endocrine system. Interacting with the hypothalamus, they together control the body, providing its vital functions.

In the pituitary gland three parts or lobes are distinguished:

1. The anterior part produces tropic hormones. They are so called, because they affect certain organs and are chemically tuned to their tissues. They include:
   - thyroid-stimulating hormone (associated with the thyroid gland);
   - adrenocorticotropic hormone (stimulates the adrenal glands);
   - follicle-stimulating hormone (controls the sexual function, induces the maturation of eggs);
   - luteinizing hormone (stimulates ovulation);
   - Growth hormone is responsible for growth;
   - Luteotropic hormone, or prolactin (regulates the appearance of colostrum and milk in pregnant women, is responsible for maternal instinct). Prolactinoma of the pituitary gland develops in the anterior lobe, it "distorts" the work of the luteotropic hormone.
2. In the posterior lobe, vasopressin (responsible for maintaining normal blood and fluid pressure in the tissues) is secreted, as well as oxytocin, which is so necessary in pregnancy and feeding the baby. It acts on the smooth muscles, cutting it.
3. In the middle part, hormones that stimulate skin cells are synthesized, - melanocytes.

Functions, as it is easy to guess, the pituitary gland are diverse. He controls the division of cells and the synthesis of protein to build new tissues. In addition, regulates the maturation of eggs and spermatozoa, as well as the body's response to the effects of sex hormones. Intervenes in the work of the immune system, stimulating or inhibiting the function of the thyroid gland. It controls the level of blood pressure in the vessels, the amount of fat mass and the quality of sleep. The pituitary body is busy 24 hours a day, 7 days a week, all our life.

Prolactinum - what is it?

A little understanding of the anatomy and physiology of the endocrine system, you can proceed to a more detailed analysis of it. Of course, with a swoop, without special training it will not be easy, but you can at least try. In the diagnosis, in addition to the word "pituitary", there was also prolactin. What it is?

Prolactin is one of the hormones secreted by the acidophilic cells of the anterior lobe of the pituitary gland. In its chemical structure, it refers to protein structures. Scientists identify a whole family of substances with similar molecular characteristics. They include:

Prolactin;
- proliferin (controls the division of cells of connective tissue);
- somatotropin;
- placental lactogen (secreted during pregnancy).

The known properties of prolactin are directly or indirectly responsible for sexual function and reproduction. The target organ is, as the name implies, the mammary glands. The hormone stimulates the production of colostrum and its transformation into milk. In puberty and during pregnancy, he is responsible for the growth and development of the mammary glands, the number of lobules and ducts. An interesting fact: receptors for prolactin have been found in virtually all organs and tissues of the human body, but it does not yet know what effect it has on them.

The prolactinoma of the pituitary gland arises from mutations in the cells of the adenohypophysis. It provokes excessive production of prolactin and enhances its properties, which affects the health and appearance of patients. Fortunately, the diagnosis and treatment of this pathology are already known and successfully tested, so this diagnosis is not a verdict at all.

Prolactinoma

Prolactinoma of the pituitary gland refers to the frequently occurring benign diseases of the anterior pituitary gland (according to statistics, up to 30 percent of the number of all diagnosed tumors). It occurs in women of childbearing age. The ratio between representatives of the strong and fair sex - 1 to 6.

Its dimensions, as a rule, do not exceed two to three millimeters, but for men, there may also be large formations - more than a centimeter in diameter. These tumors are hormonal active, since they produce prolactin. In norm it is synthesized in representatives of both sexes. Prolactin can have an effect on the organs both in itself and in conjunction with luteinizing and follicle-stimulating hormones. Especially their effect is expressed during pregnancy and lactation. But beyond that, they regulate the menstrual cycle and the onset of ovulation.

Excess amount of hormone leads to the opposite effect. A woman becomes barren, that is, can not conceive and bear a child. Men who have high titers of prolactin, have problems with potency and erection, note a subjective and objective increase in the mammary glands.

Causes

Scientists have not figured out for sure why a person has this new growth, but noticed some common signs that are typical for all patients with a similar diagnosis.

First of all, speech, of course, is about congenital genetic disorders from the endocrine system. As a rule, these are multiple neoplasms (that is, there are tumors in virtually all glands of internal secretion). There is excessive production of not only prolactin, but also hormones of thyroid and parathyroid glands, pancreas, adrenals, pituitary gland and the presence of ulcers in the stomach.

It is known that in close relatives the chance to get this pathology is higher than the average for the population. Modern genetics does not give up and is searching for genes responsible for changing the characteristics of adenohypophysis cells, but so far there has been no success in this area.

Classification

Adenoma of the pituitary gland (prolactinoma) can differ in location within the Turkish saddle. There are two groups of tumors:

1. Intrasellar prolactinomas, which do not exceed one centimeter in size and do not extend beyond the bone boundaries of the pituitary fossa.
2. Extrasellar prolactinomas that are large and expand beyond the Turkish saddle.

The size of the tumor depends on the severity of the symptoms. This applies not only to the specific action of the hormone. Volumetric tumor squeezes other brain structures, causing a common and focal neurological symptoms. It can be blindness, loss of smell, defeat of other cranial nerves (trigeminal, facial, oculomotor). Common symptoms include headaches, depression of mood, anxiety, irritability and emotional lability.

Prolactinoma of the pituitary: symptoms in women

For a long time a woman may not notice the alarming changes in her body, especially if she had problems with the menstrual cycle before the disease. In patients, there is a decrease in the number of days of menstruation, scarcity of discharge or even their absence. Ladies who want to have a baby can not do it, because ovulation does not occur.

What other symptoms do women have? Prolactinoma of the pituitary gland stimulates the production of colostrum and milk even in those women who are not prepared to become mothers. The liquid can be released by droplets when the areola is mechanically compressed, or it can flow out on its own (usually due to a large amount of milk). Women with these symptoms first think about breast cancer or other local changes, but with a thorough examination, you can find the root of the problem.

Signs of prolactinoma of the pituitary gland in women - is not only the release of colostrum and milk, it is also an increase in the fragility of bones, right up to osteoporosis. In addition, the deficiency of other sex hormones, for example estrogen, causes fluid retention in the body and rapid weight gain. Appearance can change dramatically - polymorphous acne eruptions on the skin, increased hairiness above the upper lip and on the tops of the auricles. All this should push the doctor to the idea of a pituitary tumor.

Symptoms in men

Prolactinoma of the pituitary gland in men is manifested by a decrease in the level of testosterone and a violation of the formation of sex cells. That is also causes sterility. But along with an aspermia the erection disappears, the sexual inclination decreases, the potency falls.

In addition, representatives of the strong half notice the increase and change in the shape of the breast - gynecomastia. As a rule, it is found in professional athletes targeting a set of muscle mass, and a person who does not take steroids should be a dangerous sign. Sometimes milk can leak from the enlarged breast.

Among other things, men eventually develop atrophy of the sex glands, lose secondary sexual characteristics, there is excessive fragility of bones and muscle weakness.

Diagnostics

Pituitary tumor (prolactinoma) is most often determined after a neurovisualizing examination (magnetic resonance imaging). And you need not just a survey image, but an objective search for the pathology of the pituitary gland with the use of a contrast medium - gadolinium, tropic to the neuroendocrine tissue. MRI allows you to determine the size and location of the lesion.

At small sizes of a tumor, up to one centimeter, it is necessary to use a computer tomography, since it is more informative. CT scan clearly shows bone structures and their changes in the process of adenoma growth.

But in addition to the instrumental methods that are necessary to finally confirm the diagnosis and prepare for surgery, there are also laboratory methods of diagnosis. First of all, this definition of the level of prolactin in the blood. The analysis should be carried out three times, on different days of the menstrual cycle, to exclude false positive or false negative results caused by stress or physiological fluctuations. The result, which shows more than 200 nanograms per milliliter, almost completely indicates the presence of a tumor.

If the level of prolactin ranges from 40 to 100 nanograms, it is likely that such indicators are caused by a decrease in thyroid function, chest injuries or impaired renal function. Of course, these diagnoses also do not inspire optimism.

The test with tyroliberin is most indicative. After its intravenous injection, half an hour later, an increase in the production of prolactin is observed. The concentration of the hormone must be at least twice the baseline. With prolactinoma in patients, the amount of prolactin in the blood does not change or increases slightly. If the pathological increase in the level of the hormone is caused not by a tumor, but by other causes, then the reaction to tyroliberin will be close to normal.

Do not forget about the consultation of related specialists and a thorough questioning of the patient. In order to suspect pathology, sometimes it is enough to ask the right questions.

Treatment

Treatment of prolactinoma of the pituitary gland, as a rule, is medicated. Therapy is aimed at reducing the level of the hormone and leveling its negative effects. The selection of drugs and the regimens for their administration are carried out only by an endocrinologist under the supervision of laboratory diagnostics. In the arsenal of the doctor there are such medicines as "Bromricrytin", "Levodopa", "Cyproheptadine", "Kabergolin" and others. Most patients benefit from the appointment of "Bromocriptine". The effect becomes noticeable after a few weeks. But it has a large number of side effects, so the best option is "Cabergoline." In addition, it is convenient in use (enough two sessions per week).

In the process of therapy, the size of the tumor decreases, the secretion of prolactin falls, normal vision returns, and colostrum stops flowing. In women of fertile age, menstruation appears again, and the childbearing function is restored. Men cease to be sterile, sex drive returns.

If after a long course of conservative therapy the situation has not changed for the better or negative dynamics has appeared, then the neurosurgeon together with the endocrinologist consider the question of surgical intervention. For patients who have contraindications to surgery, there is an alternative - radiotherapy. But it has drawbacks: pituitary insufficiency develops, and lifelong replacement therapy is necessary.

The diet with prolactinoma of the pituitary gland is aimed at reducing excess weight, which appeared against the background of hormonal failure. An endocrinologist or nutritionist will help to develop a nutrition plan that will contain all the necessary macro- and microelements, and also have an elevated calcium and phosphorus content necessary for the prevention of osteoporosis. Proper nutrition can be followed even after the disease is defeated.

Treatment of prolactinoma of the pituitary gland by folk remedies is highly discouraged by specialists, since infusions and decoctions do not bring the desired effect, but at the same time depress the function of the thyroid gland and adrenal glands. This can adversely affect the patient's well-being, as well as a prognosis regarding recovery. If you really want to torment yourself with grandmother's recipes, do not forget to consult a doctor.

Prognosis and prevention

Can I be cured of the prolactinoma of the pituitary gland? The consequences of the effect of excessive production of hormones on the body are such that even if the tumor itself disappears, the person will recover the lost functions for a long time. In addition, doctors do not give any predictions about the speed of recovery and the success of treatment.

Relapse occurs in about half of patients, and after surgery, statistics are even lower - only thirty percent of the cures.

Is the diagnosis "prolactinoma of the pituitary gland" a verdict? Forecasts are difficult to give. Treatment can take years and not produce any results. Once every couple of years, doctors advise you to take a break between the courses of medicine to relieve the kidneys and liver. But at the same time, cancellation of drugs can provoke malignancy and tumor growth.

Patients are assigned mandatory dispensary supervision. Every year they must do a computer or magnetic resonance imaging of the brain, consult an ophthalmologist, gynecologist and endocrinologist, and also pass tests to the level of prolactin. Such a thorough examination, comparison of indicators in the dynamics and timely adjustment of therapy make it possible to make some assumptions about the recovery of patients.