Symptoms
Pituitary adenomas are often discovered incidentally during brain imaging (CT scan or MRI) performed for another reason.
When they cause clinical signs, pituitary adenomas can lead to 3 main types of symptoms depending on their secretory nature and size.
1. Symptoms related to excessive hormone secretion by the tumor
These symptoms only occur if the adenoma is secreting.
– Cushing’s disease, secondary to ACTH hypersecretion by the adenoma (called corticotroph adenoma), stimulating adrenal cortisol production
- Weight gain predominantly in the face and trunk, Obesity
- Rounded and red face (facial erythrosis)
- Hump at the back of the neck (“Buffalo Hump”)
- Excess hair growth (Hirsutism)
- Stretch marks
- Skin fragility
- Muscle fatigability, especially in the lower limbs, causing difficulty standing up or climbing stairs
- High blood pressure
- Diabetes
Sometimes irritability, mood disorders, psychiatric disorders.
– Acromegaly, secondary to growth hormone hypersecretion by the adenoma (called somatotroph adenoma)
- Progressive thickening of the face and extremities (feet/hands)
- Soft tissue thickening
- Excessive growth of the mandible (prognathism)
- Spacing of teeth, jaw malocclusion
- Excessive sweating (hyperhidrosis)
- Snoring, sleep apnea syndrome
- Joint pain, carpal tunnel syndrome,
- High blood pressure
- Diabetes
– Hypersecretion of prolactin by the adenoma (called lactotroph adenoma or prolactinoma)
- Disappearance of menstruation (secondary amenorrhea)
- Milky discharge from the breasts (galactorrhea)
- Sexual disorders (decreased libido)
– Central hyperthyroidism secondary to TSH hypersecretion by the adenoma. This is a very rare situation (called thyrotroph adenoma).
2. Symptoms related to compression exerted by the tumor on surrounding structures
These symptoms can be seen in all types of adenomas, provided that it is sufficiently large.
– Visual disturbances related to compression of the optic chiasm located above the pituitary.
- Reduction of visual field
Decrease in visual acuity (less sharp vision quality)
– Headaches
Symptoms related to compression of nerves running along the pituitary in the cavernous sinus and controlling eye movements. These symptoms are rare in pituitary adenomas and usually indicate sudden necrosis and/or bleeding into the tumor.
– Double vision (diplopia)
– Drooping eyelid (ptosis)
3. Symptoms related to compression exerted by the tumor on the healthy pituitary gland
This compression can lead to insufficient secretion of hormones normally secreted by the pituitary.
A reduction or defect in the secretion of hormones normally secreted by the anterior part of the pituitary (hypopituitarism) results, when global, in fatigue, pallor, sexual disorders, thin skin.
– Cortisol deficiency (corticotroph insufficiency) is the most dangerous because it is associated with a vital risk when profound. It causes asthenia, low blood pressure, and digestive disorders in case of decompensation.
– Thyroid hormone deficiency (thyrotroph insufficiency) can cause pallor, weight gain, constipation, and mood disorders (depression).
– Sex hormone deficiency (gonadotroph insufficiency) is linked to a defect in the production of hormones that stimulate sex hormone production by the ovaries and testes. It can cause signs of hypogonadism (absence of puberty, amenorrhea, decreased libido, impotence, infertility)
– Growth hormone deficiency (somatotroph insufficiency) in children can cause growth retardation.
Faced with these symptoms, clinical analysis helps orient towards a pituitary pathology, and in case of suspicion, a hormonal assessment will be performed as a priority. When this suspicion is confirmed, the reference radiological examination is pituitary MRI.