Removal of pituitary adenoma surgically and without surgery

Pituitary adenoma: features of the neoplasm

The pituitary gland is a very small but very important gland located in the brain. The pituitary gland is responsible for the production of hormones that regulate growth processes, metabolism, and the function of the organs of the reproductive system. The most common pathological process affecting the pituitary gland is adenoma. It is diagnosed in 20% of patients with tumor lesions of the brain. In 95% of cases, the identified pituitary adenoma is defined as a benign tumor that does not degenerate into a malignant neoplasm and is characterized by slow growth.

Pituitary adenoma: causes and mechanisms of development

Pituitary adenoma occurs from glandular tissue localized in the anterior lobe. The reasons why the tumor occurs have not yet been clearly established. But it is believed that its formation can be caused by infectious processes in the central nervous system, injuries to the brain and skull bones, and pathological effects on the fetus during pregnancy and childbirth.

Pituitary adenoma: symptoms of a tumor process

Pituitary adenoma is characterized by a clinical picture of dysfunction of the endocrine system, metabolic processes and damage to the organ of vision. Symptoms of endocrine system dysfunction and metabolic disorders are associated with increasing production of pituitary hormones, which leads to hypercortisolism and thyrotoxicosis. Damage to the organ of vision is manifested by headache, atrophy of the optic nerves, and changes in visual fields. The severity and nature of symptoms depend on the direction of tumor growth. Accelerated tumor growth can lead to bleeding in the brain, increased headaches and other neurological disorders.

X-ray manifestations of a disease such as pituitary adenoma are reduced to changes in the shape and size of the sella turcica, thinning and destruction of the bone structures that form it.

Pituitary adenoma: benefits of treatment in Israel

The high level of medical care is largely determined by the high professionalism of doctors. There are doctors in Israel who skillfully apply the experience accumulated over many years of practice and masterfully cure even the most complex and rare pathologies.
Using the latest equipment that the country's leading clinics are equipped with, doctors skillfully and quickly carry out highly accurate, high-quality diagnostics and successful treatment using innovative technologies and techniques.
Pituitary adenoma in Israel: innovative drug treatment. Drug treatment is a priority in the treatment of pituitary adenoma. Doctors use only modern medications that are characterized by high antitumor activity and minimal side effects.
Surgical removal of pituitary adenoma in Israel is carried out using minimally invasive, low-traumatic endoscopic techniques that do not require long hospitalization and a long rehabilitation period.
Pituitary adenoma: pricing policy. Reasonable pricing policy in Israeli clinics that are members of the Association of Medical Centers is one of the main advantages of medicine in this country. Prices for basic diagnostics are fixed and do not change depending on the complexity of the disease. Since clinics operate without intermediaries, they do not require advance payment. The patient pays only for those diagnostic and treatment procedures that are prescribed to him, and only after they have been completed. Prices lower than European and American ones, as well as a high level of medical care, set Israeli medicine apart and attract thousands of patients from various countries who want to receive high-quality and not very expensive treatment.
In Israeli clinics, all conditions have been created for foreign patients so that they feel comfortable and recover quickly. Their problems - everyday and medical - are solved by employees of the International Department, who speak the native language of the patients and accompany their patients as translators and as medical curators throughout the entire treatment and diagnostic process.

Although a pituitary adenoma is a benign tumor, due to its location it can cause a lot of harm to health and even lead to serious consequences. In Israel you will be quickly and effectively relieved of this problem. To receive consultation and audit on treatment and diagnostic programs regarding adenoma, you just need to fill out an application for treatment. Our medical consultant will contact you and select the most advantageous treatment program and doctors specializing in pituitary adenoma.

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Is gamma knife radiosurgery painful or dangerous?

The use of the Gamma Knife is completely painless, although the patient may feel pain when positioning the four small metal pins to strengthen the stereotactic frame, so they are installed under local anesthesia. During the actual treatment, the patient may experience slight head movement, although there will be no pain or noise.

There may be a risk of pituitary deficiency associated with this procedure, affecting thirst and blurred vision, which may require hormone replacement therapy.

Recovery after surgery

The success of recovery after removal of a tumor depends on its size and additional features. In most cases, the person is rehabilitated and can lead a normal life. With the development of serious complications, partial loss of certain functions occurs. In the most severe situations, death cannot be ruled out.

The recovery period for pituitary adenoma after surgery lasts on average several weeks. The duration depends on the type of intervention performed. During the entire period, you need to follow several general recommendations:

It is necessary to avoid overwork and active physical activity.

avoid overwork, physical activity or strain;
comply with all medical instructions;
do not use hormonal drugs or other medications unless prescribed by the attending physician;
do not use folk remedies for recovery without prior consultation;
undergo routine examinations;
Women during lactation should stop breastfeeding.

Surgical removal of a tumor on an internal organ is a procedure associated with some risk. But the pathology cannot be ignored and not treated. Lack of therapy will cause deterioration in health and can lead to more serious consequences than surgery.

When is surgery necessary?

Densification of an internal organ usually has a negative effect on hormonal levels. It increases or decreases the production of certain hormones, which leads to unpleasant symptoms. To prevent the development of serious complications and transformation into a malignant neoplasm, doctors prescribe removal surgery.

However, surgery is not always performed. For this, the adenoma must exhibit hormonal activity. Sometimes maintenance conservative therapy is prescribed. But sometimes you can’t do without operational influence. The following factors are considered indications for it:

If the adenoma continues to grow, it is removed.

the capsule is of the hormonally active type and has a negative effect on hormonal levels. It causes disruption of the proper production of biologically active substances;
large thickenings compress neighboring tissues, causing blurred vision;
The tumor is large and continues to grow. Drug treatment did not produce results.

The final decision on the advisability of surgical intervention is made by the attending physician. To do this, he studies the results of MRI and other types of examination.

Treatment of pituitary adenoma

In medical practice, treatment of pituitary adenoma of the brain is carried out using conservative (medicinal) and surgical methods and with the help of radiosurgery, external beam radiation therapy, proton therapy, and gamma therapy. The medicinal method includes the use of bromocriptine (a prolactin antagonist, normalizes the level of prolactin hormones without interfering with its synthesis), dostinex and other analogues. Drug therapy cannot always defeat the disease, but sometimes it makes the surgeon’s task easier and increases the chances of recovery.

Stereotactic radiosurgery is a non-invasive treatment method by irradiating a tumor with a beam of radiation from different directions. The effect of radiation with this method on other glandular tissues is minimal. Treating a tumor with radiation is convenient because it does not require hospitalization, anesthesia, or preparation. If an adenoma is detected that does not synthesize hormones and does not manifest any symptoms, then the patient is observed: in the case of a microadenoma, tomography is done every two years; in the case of a macroadenoma, it is recommended to check the condition every six months or annually.

Removal of pituitary adenoma

A modern surgical method of treatment is transnasal (through the nose) removal of pituitary adenoma. This minimally invasive operation, using the introduction of an endoscope, is effective for microadenoma. If the formation has pronounced extrasellar growth, then transcranial interventions are used. Contraindications to surgery are old age, childhood, and pregnancy. In these cases, another treatment method is selected. Surgical transcranial treatment can cause some consequences:

renal failure;
impaired blood circulation in the brain;
dysfunction of the genital organs;
blurred vision;
injuries to healthy gland tissue;
liquorrhea;
inflammation and infection.

The transnasal method of adenoma removal is less traumatic and adverse consequences are minimized. After the operation, the patient spends up to three days in the hospital under observation, if the removal of the adenoma went without complications. Then the recovering person is prescribed rehabilitation measures in order to subsequently eliminate relapses.

Treatment of pituitary adenoma with folk remedies

Having learned an unpleasant diagnosis, it is common for a person to deny it and look for gentle treatment methods - folk remedies. From the point of view of traditional medicine, the treatment of pituitary adenoma with folk remedies is very doubtful. Perhaps some effect can be obtained, but the gifts of nature will not be able to correct the body’s malfunctions caused by hormonal imbalance. Delaying treatment with independent methods can be deadly, especially if a corticotropic adenoma is eventually discovered.

In addition to the main treatment, you can take herbal decoctions, but after consulting a doctor. In addition, we must take into account that some plants, for example, hemlock, are very poisonous and must be used in very measured doses, otherwise the consequences can be tragic. Among folk remedies, the following are considered effective:

bug tincture 10% in alcohol;
a mixture of ground ginger, pumpkin seeds, sesame seeds, primrose herb, honey;
hemlock tincture in oil (drip into the nose), alcohol tincture for drinking;
chaga;
snake knotweed;
Melissa;
plantain;
valerian;
rowan fruits;
sage, calendula, chamomile.

What needs to be done to prepare for this procedure?

A few days before the procedure, the patient must contact the Humanitas Clinic for a preliminary appointment and undergo a blood test, ECG of the heart, eye and hearing examinations, as well as a medical examination to ensure a complete compilation of all medical records. It is important that the patient is informed of any allergic reactions to medications or contrast agents, as well as claustrophobia. On the day of the procedure, the patient must arrive accompanied by a family member or friend. You cannot eat food from midnight the night before; You should shower with a disinfectant shampoo containing products such as chlorhexidine. It is better not to wear jewelry: brooches, hair clips, and also not to use hair cosmetics and artificial nails; wash off makeup; Wear comfortable clothes and shoes, preferably with buttons or zippers.

What are the consequences

If the tumor does not exceed 2 cm in size, then removal of the pituitary microadenoma does not lead to serious complications after surgery. In 90% of cases, complete recovery of patients and a return to a normal lifestyle is quite possible. Basically, the development of adenoma against the background of hormonal imbalance is inactive. But if you start the process, the tumor will begin to compress the brain structures and can lead to severe functional disorders:

blurred vision;
circulatory disorders in the brain;
injury to nearby healthy tissues of the pituitary gland and endocrine glands;
signs of acromegaly;
problems with the reproductive system in women;
thinning of nerve fibers;
damage to the facial optic nerve;
partial paralysis of the facial area;
liquorrhea when cerebrospinal fluid leaves the body through the nose like a nasal one, when a fatal outcome is quite likely;
memory impairment up to tissue necrosis;
adrenal insufficiency with impaired water-salt balance;
infection of tissues, development of meningitis, encephalitis as diseases that carry mortal danger;
visual disorder, when patients are already classified as having a disability.

Endoscopy by administering the drug through the nose minimizes negative consequences, but like any other surgical intervention it does not pass without a trace. To minimize unpleasant consequences, additional neurosurgical and hormone replacement therapy may be prescribed. Usually, after surgery, patients are allowed to move independently within 24 hours. Nevertheless, you will have to stay in the hospital for a long time under the close supervision of doctors until the condition becomes satisfactory.

Removal of a pituitary tumor is carried out only by neurosurgery specialists with extensive experience. Any mistakes are unacceptable and can be costly - lead to loss of performance and disability.

When the adenoma is localized in the lower medullary appendage, the recovery period is faster, the functionality of the pituitary gland is quickly restored, but constant monitoring by the attending physician is extremely necessary.

Many patients are satisfied with the results of endoscopy. Complications and consequences after surgery to remove a pituitary adenoma are minimal. Side symptoms quickly disappear: dizziness and headaches, because with endocrine disorders and intracranial pressure they become constant and intrusive.

It is important after surgery, when the pituitary adenoma is removed, to follow certain rules and doctors’ recommendations:

Do not use oral contraceptives for women; do not use certain vitamins and medications that can negatively affect hormonal levels; stop breastfeeding your baby; Be careful with homeopathy and herbal remedies, which can greatly harm the body; all home therapy methods should be discussed with your doctor.

It is unlikely that the pituitary gland of the brain will quickly recover after removal of the adenoma, so the rehabilitation period is not complete without additional treatment. According to reviews from many patients, the operation has to be performed more than once, since the tumor often begins to grow again after a short period of time. Of course, the operation does not go away without leaving a trace, it often recurs and leads to decreased vision in patients, since it involves surgical manipulations in the head area or removal of a pituitary adenoma. Consequences, relapses and complications occur frequently, including:

severe bleeding;
the development of meningitis, when recovery after removal of the pituitary gland becomes difficult.

Of course, each case after surgery is purely individual. Rehabilitation periods may vary. Endoscopy today is practiced by many doctors and has many advantages: it reduces the postoperative period and rehabilitation time. Today, removal of pituitary microadenoma in children using an endoscope is considered the gold standard, in particular among specialists in modern Israeli clinics. Endoscopy and laser therapy techniques are often combined. For example, radiology and exposure to radiation leads to a decrease in tumor size, a halt in its growth and a rapid onset of remission. Radiation therapy is carried out only when the malignant nature of the tumor appears.

Reviews

Egor, 43 years old: “My father had an open adenomectomy without dissecting the bladder at the 2nd city hospital in St. Petersburg. Dad was in bed for 2 weeks, but everything went smoothly, without consequences, without complications. I recommend any specialist from Komyakov’s team - he doesn’t employ armless doctors.”

Sergey, 54 years old: “When I first saw blood in my urine, I rushed to the first clinic I came across in St. Petersburg - SM-Clinic on Bukharestskaya. There I was successfully scammed out of 50 thousand rubles. for incomprehensible examinations and useless treatment with various drugs. As a result, I went to the district clinic, where they gave me a referral to the Alexander Hospital. They did an ultrasound there and found a mountain of stones in the bladder and a prostate adenoma (the stones were caused by it). In 3 days, two operations were performed: the stones were crushed and the adenoma was removed using the TUR method. I only bought a loop for the device and saline solution. I went home after 3 days, no pain, urination is absolutely normal. The erection was not affected, but the orgasm was dry.”

Symptoms

The signs that an adenoma may manifest vary depending on the type of tumor.

A hormonally active microadenoma manifests itself as endocrine disorders, while an inactive microadenoma can exist for several years until it reaches a significant size or is accidentally detected during examination for other diseases. 12% of people have asymptomatic microadenomas.

Macroadenoma is manifested not only by endocrine, but also by neurological disorders caused by compression of surrounding nerves and tissues.

Prolactinoma

The most common pituitary tumor occurs in 30-40% of all adenomas. As a rule, the size of prolactinoma does not exceed 2–3 mm. It occurs more often in women than in men. Manifested by such signs as:

menstrual irregularities in women - irregular cycles, prolongation of the cycle for more than 40 days, anovulatory cycles, absence of menstruation
galactorrhea - constant or periodic release of breast milk (colostrum) from the mammary glands, not associated with the postpartum period
inability to get pregnant due to lack of ovulation
In men, prolactinoma is manifested by decreased potency, enlarged mammary glands, erectile dysfunction, and impaired sperm formation, leading to infertility.

Somatotropinoma

Accounts for 20–25% of the total number of pituitary adenomas. In children, it ranks third in frequency of occurrence after prolactinoma and corticotropinoma. Characterized by increased levels of growth hormone in the blood. Signs of somatotropinoma:

in children it manifests itself with symptoms of gigantism. The child quickly gains weight and height, which is due to the uniform growth of bones in length and width, as well as the growth of cartilage and soft tissue. Typically, gigantism begins in the prepubertal period, some time before the onset of puberty, and can progress until the end of skeletal formation (up to about 25 years of age). Gigantism is considered to be an increase in the height of an adult by more than 2 – 2.05 m.
if somatotropinoma occurs in adulthood, it is manifested by symptoms of acromegaly - enlargement of the hands, feet, ears, nose, tongue, changes and coarsening of facial features, the appearance of increased hair growth, beards and mustaches in women, menstrual irregularities. Enlargement of internal organs leads to disruption of their functions.

Corticotropinoma

Occurs in 7 - 10% of cases of pituitary adenoma. Characterized by excess production of adrenal hormones (glucocorticoids), this is called Itsenko-Cushing disease.

Signs of corticotropinoma:

“Cushingoid” type of obesity – there is a redistribution of the fat layer and fat deposition in the shoulder girdle, on the neck, in the supraclavicular areas. The face takes on a “moon-shaped”, round shape. The limbs become thinner due to atrophic processes in the subcutaneous tissue and muscles.
skin disorders - pink-purple stretch marks (striae) on the skin of the abdomen, chest, thighs; increased pigmentation of the skin of the elbows, knees, armpits; increased dryness and flaking of facial skin
arterial hypertension
Women may have menstrual irregularities and hirsutism - increased skin hair growth, beard and mustache growth
Men often experience a decrease in potency

Gonadotropinoma

Rarely found among pituitary adenomas. It manifests itself as menstrual irregularities, more often the absence of menstruation, decreased reproductive function in men and women, against the background of reduced or absent external and internal genital organs.

Thyrotropinoma

It is also very rare, occurring in only 2–3% of pituitary adenomas. Its manifestations depend on whether the tumor is primary or secondary.

Primary thyretropinoma is characterized by symptoms of hyperthyroidism - weight loss, trembling of the limbs and the whole body, bulging eyes, poor sleep, increased appetite, increased sweating, high blood pressure, tachycardia.
For secondary thyrotropinoma, that is, arising from long-term decreased function of the thyroid gland, hypothyroidism is characteristic - swelling on the face, slow speech, weight gain, constipation, bradycardia, dry, flaky skin, hoarse voice, depression.

Neurological manifestations of pituitary adenoma

visual impairment - double vision, strabismus, decreased visual acuity in one or both eyes, limited visual fields. Significant sizes of adenoma can lead to complete atrophy of the optic nerve and blindness
headache that is not accompanied by nausea, does not change with changes in body position, and is often not relieved by taking painkillers
nasal congestion caused by germination of the sella turcica into the bottom

How are pituitary adenomas treated in Israel?

A pituitary tumor does not always require surgical removal. If the neoplasm is small, does not interfere with the patient and does not secrete hormones, you can limit yourself to observation. The doctor may ask the patient to repeat the MRI the following year. This is done to check whether the tumor is growing. If the tumor does not grow, no treatment is given.

Drug treatment

For those types of tumors that secrete prolactin, there is drug treatment - drugs that block the release of prolactin and help shrink the tumor.

Radiosurgery

In some cases, radiosurgery is used in Israel to remove pituitary adenomas - a single irradiation using a gamma knife system.

Before the procedure, the patient undergoes an MRI, on the basis of which radiation is planned. The procedure, including preparation, can last from 1 to 6 hours. Treatment is performed on an outpatient basis: the patient goes home the same day.

Surgical intervention

In Israel, surgery for pituitary adenomas is most often performed endonasally - through the nose.

For tumors that do not produce hormones
, operations are very effective.
If the tumor produces hormones
, the effectiveness is also quite high, but in some cases the hormonal balance is not completely restored, because it is not always possible to completely remove such a tumor. However, in 85-90% of cases these operations are effective.

Senior physician of the surgical department of the Ichilov-Suraski Medical Center.

Since the operation does not involve craniotomy and does not affect the brain, the patient recovers very quickly. Within a day after the procedure, the person gets to his feet and can eat and drink on his own. As a rule, the patient is left in the hospital for an additional 2 days after surgery to ensure that there are no hormonal imbalances.

Advantages of treating pituitary adenoma in Israel

In Israeli clinics, microsurgical techniques are used in the treatment of pituitary adenomas, which makes the operation more effective and safe. The doctor uses a tiny microscope that performs 2 tasks:

Transnasal adenomectomy - through the nose

Removal is carried out in several ways. The most common method involves inserting an endoscope through the nasal passage. The equipment contains a miniature video camera, with which the doctor fully controls all manipulations.

This type of impact is used for small-sized capsules and is considered low-traumatic. Transnasal removal of a pituitary adenoma is performed through both the left and right nostril. The surgeon inserts equipment into the cavity, the diameter of which is no more than 0.5 cm. The picture is displayed on the screen.

Application of methods of treatment of pituitary adenoma

The leading treatment method for prolactinomas is drug therapy with dopamine agonists. The effectiveness of their treatment reaches 80%. It is possible to normalize the menstrual cycle and prolactin levels, and restore the reproductive function of the body.

Reduction in the size of prolactinoma over 1 year when treated with dopamine agonists.

However, complete resorption of pituitary adenoma is rare. In addition to the need for constant medication, patients with macroprolactinomas need to remember the possibility of activation of the growth of pituitary adenoma during pregnancy, which may require surgery before birth.

Also, the negative aspects of drug therapy include a relatively high (compared to other hypertension) risk of hemorrhage into the tumor, reaching 15%-20%. Sometimes such apoplexy can lead to severe neurological disorders and require emergency surgical intervention. In case of non-or low effectiveness of drug therapy, surgical and, last but not least, radiation treatment of pituitary adenomas is performed.

In addition to situations where there is no effect from treatment with dopamine agonists, there is poor tolerability of drugs, indications for neurosurgical treatment may be the development (possibility of development) of nasal liquorrhea with or without drug treatment with infrasellar growth of the pituitary adenoma tumor, the presence of visual or other severe neurological disorders with other variants of its extrasellar distribution.

Radiation therapy for pituitary adenomas is carried out when patients refuse surgical treatment, when the disease recurs after surgery, or when there are contraindications to surgical treatment.

In the treatment of Itsenko-Cushing's disease when an adenoma is identified, the method of choice is neurosurgery.

In case of undiagnosed pituitary adenoma or the impossibility of performing neurosurgical intervention, radiation treatment (proton beam, gamma therapy) is used.

The disadvantages of proton therapy are the duration of remission (8-12 months, but can last for 1.5-2 years), the need to combine it with adrenalectomy in moderate and often severe forms of the disease, the development of complications in the form of hypothyroidism, hypogonadism, and GH deficiency. Gamma therapy is rarely used for macroadenomas and the impossibility of neurosurgical treatment.

Drug therapy (central acting drugs - Abergin, Parlodel, steroidogenesis blockers - Chloditan, Mammomit, Nizoral) is used as a preparation for or after the main methods of treatment, as well as to reduce the time of remission.

Adrenalectomy can be used in combination with radiation therapy for undetected pituitary adenoma, when radiation and neurosurgical treatment methods are ineffective.

Treatment of inactive pituitary adenomas is usually surgical. At the endosellar stage of development, treatment of inactive adenomas may consist of prescribing dopamine agonists (as a rule, the effect is insignificant) and sex hormone preparations, taking into account their possible secondary origin with an early decrease in gonadal function, however, with the development of cephalgic syndrome, an increase in the volume of the tumor of the pituitary adenoma may become a question about surgical removal.

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Craniotomy - craniotomy

This method is not the most popular due to the high risk of complications. It is used if the adenoma has significantly increased in size or is located beyond the border of the sella turcica. This makes removal through the sinuses impossible. Craniotomy is a procedure in which the tumor is accessed through the cranial bones.

During the intervention, craniotomy is performed. The pituitary gland is accessed either through the temporal lobes or through the frontal part. This depends on the location of the cavity and other features. During the procedure, general anesthesia is administered.

The patient is placed on his side, the skull is opened and the dura mater of the brain is excised. When the surgeon gets to the gland, he uses an ultrasonic aspirator or electric tweezers. They are used to remove the contents of the capsule. In rare cases, it is necessary to excise not only the adenoma, but also the pituitary gland itself. This usually happens if the overgrown tissue has penetrated deep into the internal organ.

After the operation, the vessels are cauterized to stop bleeding. Then the doctor returns the fragment of the skull bone to its place and applies fastening sutures. The entire procedure takes about 4 hours. The patient is monitored in the intensive care unit for 24 hours to exclude the development of complications. He will spend another 1 - 1.5 weeks in the hospital, where he will recover.

Craniotomy is successful in almost 70% of cases. But, the larger the size of the tumor, the higher the risk of developing postoperative complications. After intervention, sometimes the disease relapses. In more than 20% of cases, a tumor forms again on the pituitary gland.