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Pituitary Tumors


The pituitary is a tiny pea-sized gland at the base of the brain. It serves as the body's "command center," producing hormones that regulate growth and metabolism as well as the actions of other glands, including the thyroid, adrenals and gonads (ovaries in women and testes in men).

Tumors arising from the cells of the pituitary gland are also known as pituitary adenomas. They are almost always benign, but can have significant side effects when they produce excessive amounts of hormones, grow large enough to affect normal pituitary function or interfere with surrounding structures, particularly the optic nerves, which are responsible for sight.

 

Types of Pituitary Tumors
Pituitary tumors can be divided into two broad categories:

Non-functioning Tumors
Non-functioning tumors don't produce hormones. Symptoms are generally associated with the tumor's growth and its effects on nearby structures, including the optic nerve and other cranial nerves. Non-functioning tumors may also interfere with the pituitary gland's normal production of hormones.

Functioning Tumors
Functioning tumors are those that produce excessive amounts of specific hormones, each with its own set of symptoms.

 

Types of Functioning Tumors
Thyroid-stimulating hormone (TSH): Tumors that overproduce this hormone cause the thyroid to release excessive amounts of thyroxine, which can lead to hyperthyroidism (overactive thyroid), although pituitary tumors are a rare cause of this condition. Symptoms include:

  • Weight loss
  • Nervousness
  • Rapid or irregular heartbeat

Prolactin: Prolactin stimulates breast growth and milk production in women. A pituitary tumor that overproduces this hormone is called a prolactinoma. Symptoms in women include a milky discharge from the nipples, irregular menstrual periods or the absence of menstruation. Symptoms in men include:

  • Erectile dysfunction and/or impotence
  • Infertility
  • Loss of body hair
  • Decreased sex drive
  • Rarely, increased breast growth (gynecomastia)

Growth hormone (GH): GH regulates linear growth in children and has various effects on the body's metabolism. Tumors that overproduce GH result in acromegaly in adults and gigantism in children.

Symptoms of acromegaly include:

  • Gradual enlargement of the hands, feet, jaw and/or forehead
  • Coarse facial features, such as thickened skin and enlarged nose or lips
  • Heart problems
  • High blood pressure
  • Excessive sweating

Adrenocorticotropic hormone (ACTH): This hormone stimulates the adrenal glands to produce cortisol, which plays a role in the body's response to stress and helps regulate blood pressure and heart function, among other duties. Overproduction of ACTH leads to Cushing's disease.

Symptoms of Cushing's disease include:

  • Rounded "moon" face
  • Weight gain, particularly in the trunk and abdomen
  • Thinning of the skin
  • Purple-red stretch marks
  • Diabetes
  • High blood pressure

Pituitary carcinoma: In rare cases, a pituitary tumor can become cancerous and metastasize (spread) to other areas of the body. In most cases, pituitary carcinomas do produce hormones, particularly prolactin and ACTH. Symptoms would be similar to tumors producing those hormones, but may also include symptoms from the tumor's growth affecting nearby areas such as the optic nerve.

Specific symptoms depend on the type of hormone secreted by a pituitary tumor. Symptoms resulting from the size of the tumor may include headaches, double vision and loss of vision due to impingement of the optic nerves.

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Clinical trials
Ensayo de fase 1a/2a, abierto y multicéntrico, para investigar la seguridad, tolerabilidad y actividad antitumoral de dosis repetidas de Sym015, una mezcla de anticuerpos monoclonales dirigida frente al receptor MET, en pacientes con tumores malignos sólidos en fase avanzada
Estudio fase IIIB, prospectivo, randomizado, abierto que evalúa la eficacia y seguridad de Heparina/Edoxaban versus Dalteparina en tromboembolismo venoso asociado con cáncer.
Tumores sólidos. Antiemesis Estudio fase III, multicéntrico, aleatorizado, doble ciego, con control activo para evaluar la seguridad y eficacia de Rolapitant en la prevención de náuseas y vómitos por la quimioterapia (NVIQ) en pacientes que reciben quimioterapia altamente emética (QAE). A phase III, multicenter, randomized, double blind, placebo controlled study of the safety and efficacy of Rolapitant for the treatment of Chemotherapy-induced nausea and vomiting in subjects receiving highly Emetogenic Chemotherapy (HEC)
Ensayo clínico en fase I de determinación de dosis del antiangiogénico multidiana Dovitinib (TKI258) más paclitaxel en pacientes con tumores sólidos.

There are few known risk factors for pituitary tumors. The only confirmed risk factor is multiple endocrine neoplasia type 1 (MEN 1), a hereditary condition that increases the chance of developing certain pituitary tumors.

Pituitary tumors can be difficult to diagnose, particularly in the early stages. Non-functioning tumors may not cause any symptoms until they grow larger, and symptoms of functioning tumors are similar to those of many other medical conditions. In fact, many pituitary tumors go undiagnosed for many years.

There are several types of tests used to diagnose pituitary tumors. The doctor will decide which tests to conduct based on the patient's symptoms.

 

Blood & Urine Tests
There are specific blood and urine tests for each type of hormone-producing pituitary tumor. Some tests, called stimulation tests, involve infusing a small amount of the suspected hormone into the blood and then measuring hormone levels to determine if the pituitary is functioning properly. Other tests may involve infusion of a drug that attempts to suppress hormone production.

 

Imaging Tests
A magnetic resonance imaging (MRI) scan is very good at detecting pituitary tumors of all sizes.

Treating pituitary tumors may involve surgery to remove the tumor, drug therapy to reduce excessive levels of hormones produced by the tumors, radiation therapy to shrink tumors or a combination of these therapies. Treatments for each patient are determined by the tumor's location, size and the specific hormones being overproduced.