 |
|
|||||||||
May 23, 2006
Diagnosed with Pituitary tumor?! What now?
by MariAnne
The pituitary gland lies inside the skull, just above the nasal passages. Those passages are above the fleshy back part of the roof of the mouth. It sits in a tiny bony space called the sella turcica, and is connected directly to part of the brain called the hypothalamus. This connection to the hypothalamus provides a key link between brain activity and the endocrine system for the pituitary gland.What are the functions of a pituitary gland?The pituitary gland is a half-breed in many ways; it is not really a part of the brain, but rather hangs beneath it. Half of the gland comes down from the brain, its posterior lobe, which controls the body’s water levels and secretes the anti-diuretic hormone (ADH). The other half comes from tissues originating from the roof of the embryonic mouth. That is the anterior lobe, which controls sex hormone levels, lactation, growth hormone, body steroids, and the thyroid gland. The pituitary is responsible for almost all of the body’s hormonal systems. As elsewhere in the brain, tumors of the pituitary gland behave according to their cell of tumor’s origin. Most of these tumors are truly benign, although on occasion they may prove to be malignant, known as pituitary carcinomas. Almost all pituitary tumors have a good prognosis, which calls for total removal. On the other hand, almost all can eventually become malignant by position. This is especially true when the tumors grow off to either side, involving the packed structures behind both eyeballs. Therefore, these tumors may occasionally present the patient with double vision, or even something called pituitary apoplexy. This involves severe sudden headache, loss of or double vision, and protruding eyeballs. Each tumor, because of its extraordinarily high hormonal output, creates a characteristic clinical syndrome. In some way this is desirable, because it brings attention to the tumor. What are pituitary tumors?Pituitary tumors are abnormal growths found in the pituitary gland. Is there any treatment?The best treatment of pituitary tumors is requires that the patient gets diagnosed in the early stages. Treatments include surgical removal of the tumor, radiation therapy (using high-doses of x-rays to kill tumor cells), and drug therapy (using certain medications to block the pituitary gland from producing too many hormones). However, the most common treatment of a pituitary tumor is surgery. The treatment may depend on whether the tumor is a carcinoma (malignant tumor), or adenoma (benign tumor). Furthermore, treatment of an adenoma depends on whether it is functional and, if so, which hormone it secrets. Surgery helps remove the tumor, while drugs can relieve symptoms and sometimes shrink the tumor. After finding the tumor, your doctor should discuss treatment options with you. It is important to take your time and think about all the choices you have. You may want to get a second opinion as well. Because pituitary tumors are rare, not many doctors have much experience with them, so your doctor should not mind if you choose to get a second opinion. In addition, whether the treatment is surgery or radiation, it requires a doctor experienced with treating pituitary tumors. Follow-up care after pituitary tumor diagnosis In many cases of functional pituitary adenomas, having hormone measurements is prudent, preferably within days or weeks after surgery or radiation, to see if the treatment was successful. After any pituitary tumor treatment you should also have blood tests to see how well the remaining normal pituitary tissue is functioning. If the results show that the adenoma was completely removed or destroyed, and that pituitary function is normal, you will still need periodic checkups with your doctor. You need to have hormone level measurements again in the future to check for recurrence of the adenoma. After treatment, you will need checkups for several years at least. The response to radiation therapy is impossible for doctors to predict, and although side effects can occur within months, some may take years to appear. That is why the doctor will check your pituitary function at regular intervals. MRI scans and other imaging tests will be the main follow-up tests along with hormone level testing. This is especially the case if your tumor produced hormones. If you are taking medicine for the treatment of a prolactinoma, you will have hormone levels checked once or twice a year, as your doctor choses. If an MRI shows that the tumor has shrunk after treatment, there is no need to repeat the MRI. However, this depends on the size of the tumor, and whether the tumor’s response is partial or complete. If you have a prolactin-producing microadenoma, after several years of therapy your doctor may attempt to stop the medicine. This is important to see if your prolactin level remains normal. Patients who develop pituitary hormone deficiency after surgery or radiation therapy will need hormone replacement to balance hormone levels. The thyroid hormone and adrenal steroids can be supplied by oral medicine. Men could receive testosterone to restore the sex drive and function, either by injection every 3 weeks or by a patch applied to the skin. Young women should receive estrogen, either in pill form or as a skin patch, to avoid premature menopause. Pituitary hormone deficiency may also interfere with a woman’s ability to have children. However, if she wishes to become pregnant, it may be possible to restore fertility by hormone therapy. Occasionally, people with pituitary adenomas may be disabled or die because the tumor or its treatment destroys vital brain tissue near the pituitary gland. This is unusual since, in general, when a pituitary tumor did not cure, people live out their lives but may have to deal with the ongoing side effects of the tumor and its hormone overproduction. Follow-up care is particularly important after a patient receives treatment for pituitary tumors. Lifestyle changes commonly happen in this period, when you should look at your life in new ways. Maybe you are thinking about how to improve your long term health; some people even begin this process during cancer treatment. Try to make healthier choices, and think about your life before you learned you had cancer. Now is not the time to feel guilty or to blame yourself, but you can start making changes today that can have positive effects for the rest of your life. Not only will you feel better but you will also be healthier with these life changes. You can start by working on those things that you feel most concerned about, and get help with those that are harder for you. Diet and nutrition are also important, although eating right can be a challenge for anyone. For instance, treatment for pituitary tumor often changes one’s sense of taste. Nausea can be a problem, and you may lose your appetite for a while and lose weight when you do not want to. On the other hand, some people gain weight even without eating more, so this can be frustrating. Work and exercise could also help you after pituitary tumor treatment. Fatigue is a very common symptom in people who received treatment. For some this fatigue lasts a long time after treatment, and can discourage patients from physical activity. However, you have to be aware that exercise can actually help you reduce fatigue. Talk with your health care team before starting with this program. Try also to get a doctor’s opinion about your exercise plans. It is important to know that exercise improves your cardiovascular system, strengthens your muscles, reduces fatigue, and lowers anxiety and depression. It makes you feel generally happier and helps you feel better about yourself. In the long term, we know that exercise plays a role in preventing some forms of cancer. Once your treatment for pituitary tumor ends, you may find yourself overwhelmed by emotions, which happens to many people. However, now you may find that you think about the potential of your own death, or the effect of your cancer on your family, friends, or career. For some people that can be a source of anxiety, so this is an ideal time to seek out emotional and social support. You need people you can turn to for strength and comfort, so try to find it in family, friends, cancer support groups, religious or spiritual groups, online support communities, or individual counselors. |
|
|||||
|
|
