Pituitary Gland:
The endocrine system is made up of glands that secrete chemicals called hormones into the bloodstream. The Pituitary gland, a pea-sized structure is the master gland. It is located at the base of the brain just behind the nose. The pituitary controls the other glands of the endocrine system and keeps hormone levels in check. The pituitary gland is controlled by substances (releasing or inhibitory factors) that are sent by the hypothalamus. The pituitary gland, in turn, secretes hormones into the bloodstream. Most of these hormones are chemical messengers that instruct various glands to secrete their own hormones.
Functions of Pituitary Gland:
The pituitary gland controls several important bodily processes .Some of the key hormones includes:
Adrenocorticotropic hormone (ACTH) - stimulates the adrenal glands to produce the hormone cortisol, essential to regulate blood pressure and blood sugar levels.
Antidiuretic hormone (ADH) - also called vasopressin, regulates water balance.
Follicle stimulating hormone (FSH)- and luteinising hormone (LH) - regulate the menstrual cycle in women, sperm production in men and sex hormone levels in both sexes.
Growth hormone- influences an individual’s height, contributes to bone and muscle building and restricts accumulation of body fat.
Oxytocin - involved in childbirth and breastfeeding. This hormone is also thought to play a role in counteracting the physical effects of stress.
Prolactin - stimulates milk production from the breasts after childbirth to enable nursing. It also affects sex hormone levels from ovaries in women and from testes in men.
Thyroid stimulating hormone (TSH) - stimulates the thyroid gland, which regulates the body's metabolism, energy, growth, and nervous system activity.
Pituitary Tumour:
A pituitary tumour is a mass of cells that grow on the gland. Some secrete hormones. The majority of pituitary tumors (adenomas) do not spread outside the skull (nonmetastatic) and usually remain confined to the pituitary gland or nearby brain tissues. Generally, pituitary tumours are benign and slow growing, and pituitary cancers are extremely rare. Benign tumours don’t spread to other parts of the body, so there is no chance of secondary tumours developing. The pituitary gland is divided into two main parts: The anterior pituitary and the posterior pituitary. Two-thirds of all pituitary tumors occur in the anterior or front portion of the gland.
Types of Pituitary Tumours:
Pituitary tumors can be divided into two broad categories:
Non-functioning Tumors/Non-Secretory Tumors: The hormonally quiet tumor grows to oversized proportions, actually growing to the point of lifting up and stretching the optic nerves (especially where the nerves from both eyes cross as they travel to the brain) and other cranial nerves. These tumors can grow to be quite large as they do not signal their presence with an excess of hormones. They are usually found only when symptoms of compression are noted.Non-functioning tumors may also interfere with the pituitary gland's normal production of hormones.
Symptoms of Non Functioning Tumours:
Loss of peripheral vision is often the first sign
Decreased energy
Hair loss
Low blood pressure
Weight gain
Impotence
Menstrual irregularity
Functioning Tumors/Secretory Tumours: Functioning tumors are those that produce excessive amounts of specific hormones, each with its own set of symptoms. Functioning/ Secretory pituitary tumors are named after the hormone they secrete:Prolactin (PRL) Tumours - PRL tumors are the most common pituitary tumour. PRL stimulates lactation in women. PRL tumours cause excess PRL production.
Symptoms PRL Tumours:
In men excess PRL leads to impotence, infertility, erectile dysfunction.
Irregular menstrual cycles or cessation of menses (amenorrhea)
Inappropriate production of milk (galactorrhea),
Loss of body hair
Decreased sex drive
Growth Hormone (GH) Tumours – approximately 20 percent of all pituitary tumors are GH secreting tumors. It stimulates the liver to produce another hormone, Somatomedin - C or Insulin-Like Growth Factor-1 (IGF-1). This hormone, in turn, regulates the growth of bones, muscles and many other organs. These tumors produce excess growth hormone.
Symptoms of GH Tumours:
In children, excess production leads to gigantism
In adults, it leads to enlargement of the hands, feet and jaw (acromegaly).
Diabetes mellitus,
Hypertension
Some develop colon polyps and cancer.
Coarsened facial features
Misaligned teeth (malocclusion)
Degenerative arthritis
Excess sweating
Adrenocorticotropic Hormone (ACTH or Cushing's disease -ACTH stimulates the adrenal gland, to secrete cortisol a glucocorticosteroid). Among other things, Cortisol helps the body deal with stress and disease. ACTH tumors represent 15 percent of pituitary tumors. They are more common in women than men. Cushing's syndrome can be a result of many things, including excessive intake of commonly prescribed medications containing steroids.
Symptoms of Adrenocorticotropic Hormone (ACTH):
Hypertension and excessive hair growth (Hirsutism)
Exaggerated facial roundness moon face
A characteristic hump on the upper part of your back, excessive fat buildup in various areas, neck (buffalo hump) and abdomen
Muscle weakness
Stretch marks
Thinning of your skin, Bruising
Depression
Centripetal obesity
Osteoporosis (thinning of the bones)
Thyroid Stimulating Hormone (TSH) Tumour - TSH stimulates the thryroid gland to secrete thyroid hormone, which regulates metabolism. TSH tumours are rare.
Symptoms of Thyroid Stimulating Hormone (TSH) Tumour: Excess production leads to hyperthyroidism
Sudden weight loss
Rapid or irregular heartbeat
Nervousness or irritability
Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) - In women, FS and LH help regulate egg production by the ovaries and control the menstrual cycle. In men, these hormones help regulate the testes' production of sperm and testosterone. Excess production can lead to abnormalities with these functions. These tumors are also rare.
Diagnosis: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
Preliminary Diagnosis:
Family history of pituitary gland tumors, hyperparathyroidism (overactive parathyroid gland), multiple kidney stones, multiple stomach ulcers, hypoglycemia (low blood sugar) or pancreatic gland tumors is examined.
A physical examination identifies signs of pituitary tumors and other health problems.
A neurological examination includes visual field testing, hearing, balance, coordination and reflexes.
Depending on the results, the physician may request one or more of the following tests:
Biochemical Testing - Blood and Urine Test are used to measure hormone and to detect excess production or deficiency. Often, further hormone stimulation or suppression testing is needed.
Magnetic Resonance Imaging (MRI) Scan - MRI, the standard imaging test for pituitary tumors, uses magnetic fields and radio waves to generate images. MRI can easily identify large tumors (macroadenomas) of the pituitary gland and is also good at identifying most small tumors (microadenomas). But MRI may not detect many microadenomas smaller than 3 millimeters (about one-eighth of an inch).
Petrosal Sinus Sampling - Adrenocorticotropic (ACTH) hormone-secreting pituitary tumors are often too small for detection by MRI scans. When patients have blood or urine tests indicating excess ACTH production, but MRI results are normal, petrosal sinus sampling testing may be recommended. This test determines if an ACTH-secreting pituitary tumor is present and also can help define its location.
Biopsy - A biopsy (taking a sample of a tumor and examining it under a microscope) may occasionally be recommended by your doctor for definitive verification. Pituitary tumors can be examined under a microscope before or after surgery to determine the tumor type. Treatments for Pituitary Tumours: 60-70 percent of small, nonfunctioning pituitary tumors are carefully observed over time and do not require treatment. Treatment is considered if the tumor grows and causes symptoms. If there is no growth, observation is continued.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. Treatment options include:
Medical Treatment of Pituitary Tumours : Treatment with medications may help in blocking excess hormone secretion and can sometimes shrink certain types of pituitary tumors.
Prolactin hormone-producing tumors are often treated with Dopamine agonists (eg cabergoline, bromocriptine); Octreotide or long-acting versions which decrease secretion of prolactin hormone and generally reduce tumor size.
They are usually so effective that surgery is not required.
Growth hormone-producing tumors can be treated with two classes of medications. These medications are typically recommended when surgery has been unsuccessful in treating excess hormone production
Somatostatin analog drugs decrease growth hormone production and may decrease tumor size.
Pegvisomant blocks the effects of excess growth hormone production on the body.
Surgical Treatment of Pituitary Tumours :-Surgery is often done to remove the tumor and is generally considered to be the primary treatment for pituitary tumours. The effectiveness of surgery depends on tumor type, location, size, and whether it has spread into nearby tissues. The rest of the normal pituitary gland may be damaged during surgery.This can be treated by replacing the missing hormones with pills or other forms of hormone replacement.
Transphenoidal Endoscopic Tumor RemovalPituitary tumor is removed through the nasal cavity using a microscope and endoscope-assisted technique that results in no visible incision. Traditionally, this approach was done through an external incision under the lip. In this surgery no other part of the brain is touched and there are hardly any neurological complications without leaving any visible scarThis technique also requires a shorter operating time and hospital stay than the traditional method. Most patients stay in the hospital overnight and experience a dull headache for several hours up to several days after surgery. If the tumor is small, the cure rates after surgery is about 70-80%. If the tumor is large or has affected the nearby eye nerves or brain tissue, removing the entire tumor becomes more difficult. But,in most cases, the majority of the tumor can be removed successfully.
Radiation TherapyRadiation therapy involves the use uses high-energy rays to destroy tumors to destroy tumor cells. Radiation therapy is often recommended when pituitary tumors persist or return after surgery and cause symptoms not relieved by medications. It also may be used if surgery is not possible.
The types of radiation therapy used to treat pituitary tumours include
Conventional Therapy/ External-beam Radiation - In External-beam radiation therapy, radiation is directed at the pituitary from a source outside the body. Although effective, this therapy has some drawbacks. It can take years before the tumor growth and/or hormone production is fully regulated. There could be some damage to surrounding nerves and normal pituitary functions can also be affected.
Stereotactic Radiosurgery - Stereotactic radiosurgery is the most commonly recommended treatment when surgery has not been successful. This technology allows an intense and high dose of radiation beam is targeted directly at the tumor to deliver the tumor with minimal exposure to surrounding healthy tissue. . Unfortunately, this therapy cannot be used for tumors in close proximity to important nerves, such as those needed for vision.
Proton Beam Radiotherapy - A beam of protons (positively charged particles) is directly focused on the tumor.
Fractionated Stereotactic Radiotherapy - This technique delivers carefully targeted radiation to areas of tumor growth over the course of multiple therapy sessions that deliver smaller units of radiation. The number of treatments depends on tumor size and location.
Gamma Knife Radiosurgery - Gamma knife radiosurgery has the advantage of delivering a high dose of radiation in a single fraction while minimizing the risk of damage to the nearby visual nerves and normal pituitary gland. Also, Gamma Knife offers the convenience of a single treatment compared to several weeks of fractionated radiation therapy. Overall, Gamma Knife radiosurgery has a very high chance of preventing further tumor growth -- and in some cases shrinking the residual tumor -- with very little risk of visual loss or damage to the hypothalamus. While Gamma Knife radiosurgery can be utilized as either the primary or secondary treatment for pituitary tumors, it is generally reserved as second-line therapy after residual or recurrent tumor is noted.
Treatment Options for Complicated CasesTranscranial Tumor Removal - Usually, it is the procedure is for large and complicated tumors. It also is recommended when the pituitary tumor is in a location that cannot be accessed using the transphenoidal endoscopic technique.
Chemotherapy - Chemotherapy can reduce over-production of hormones from pituitary tumors, or block the effects of these hormones. This treatment is an option when the tumor has spread beyond the pituitary gland.
Benefits of Treatment for Pituitary Tumours:
Treatment can be given for different types of pituitary tumour and the potential benefits will vary for each person. Doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical symptoms of pituitary Tumours. Many treatments used today are less intensive and more effective than treatments used in the past which makes recovery after surgery quicker.
Treatment of pituitary tumours is usually very successful, although many people will have to continue taking hormone replacements, sometimes for the rest of their lives. Regular check-ups at an endocrinology clinic are likely and may continue for several years. Patients may have further scans performed and will have blood tests to monitor your hormone levels.
Better methods of surgery to remove pituitary gland tumors are being investigated. Even large tumors and tumors that have invaded nearby structures are now able to be removed with surgery.
People recovering from a pituitary gland tumor are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended certain tests. Moderate physical activity can help you rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level.
Pituitory Tumours Treatment and Surgery in India: Medical and health care services in India are attracting over a million patients every year and have made India a popular destination for different types of medical treatment, surgical procedure, and complementary therapies. Extremely high standard of quality care is maintained in all the major hospitals and other medical canters of India. People seek medical treatment and facilities which is either unavailable in their country or is highly expensive and unaffordable are attracted by the benefits of treatment in India. It is very important to consider the treatment options for pituitary tumours very carefully. India offers extremely talented surgeons and health professionals. All the major hospitals have highly experienced and internationally trained doctors who are adept in handling major treatment and surgeries including the Pituitary Tumour treatment and surgery. Cities offering bestPituitory Tumours Treatment and Surgery in India are;
Mumbai
Hyderabad
Kerala
Delhi
Pune
Goa
Bangalore
Nagpur
Jaipur
Chennai
Gurgaon
Chandigarh
Cost of Pituitary Tumours Treatment and Surgery in India: India offers the most cost effective medical services in the world without compromising on the quality. This enables patients to regain control of their lives through opting for private overseas healthcare and surgery in India. Wide range of procedures is offered at the spotlessly clean hospitals. Surgeons speak English and are using the latest state of art hi-tech apparatus and technology. All surgery and treatments are tailored and developed to consider the needs of the travelling patient. India gives you the opportunity to have high class immediate surgical and medical treatments which includes Pituitary tumor treatment and surgery at low cost. The healthcare and surgery costs for pituitary tumours are lower than those found in other medical tourism destinations such as France, Belgium and Germany.
Some of the common countries from which patients travel to India for surgery are:
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