Vision changes

Introduction Symptoms and signs of pituitary tumors have visual field changes. Pituitary tumors are a group of tumors from residual cells of the anterior and posterior pituitary epithelium. Pituitary tumors account for about 10% of intracranial tumors. Asymptomatic small tumors are dissected. More discoverers. In this group of tumors, the adenomas were the majority, and those from the posterior lobe were rare. The clinical manifestation is the expansion of the lesion, the excessive secretion of hormones, or the enlargement of the tumor to compress the normal pituitary tissue and reduce the secretion of hormones. It is characterized by secondary gonads, adrenal cortex, and hypothyroidism.

Cause

There are two theories about the pathogenesis, one is the pituitary cell self-defect theory, and the other is the hypothalamic regulation disorder theory.

1. Hypothalamic regulation disorder

(1) The hypothalamic polypeptide hormone promotes the proliferation of pituitary cells. After transplantation into the GHRH gene, it can trigger the proliferation of GH cells in rats and further develop into a true pituitary tumor.

(2) The lack of inhibitory factors can also promote tumorigenesis. For example, ACTH adenomas can occur in patients with primary adrenal insufficiency.

2, pituitary cell self-defect theory

(1) Pituitary adenomas are derived from a mutated cell, followed by cell replication resulting from monoclonal amplification or self-mutation.

(2) Intervention of external triggering factors or lack of inhibitors:

Defects in 1DA (dopamine) receptor gene expression.

2 The role of oncogenes and tumor suppressor genes: Oncogenes are actually a type of genes involved in the regulation of normal cell growth. Some oncogene products are growth factors and their receptors, while others are involved in the transmission of growth signals in cells. The process, its abnormal expression can lead to abnormal cell proliferation.

an examination

Related inspection

Optic nerve examination

Clinical manifestations: one is the expansion of the lesions, the second is the abnormal secretion of hormones, or excessive secretion, or the tumor enlarges the normal pituitary tissue and reduces the secretion of hormones, which is characterized by secondary gonads, adrenal cortex, thyroid function. Reduced symptoms.

Space-occupying lesions of pituitary tumors can affect local and adjacent tissues. Pituitary tumors larger than 1 cm in diameter can have severe headaches due to compression of the saddle. If the development of the optic nerve is reversed, the visual field is reduced, and the visual field defect is mainly unilateral hemianopia or bilateral hemianopia. Development upwards can affect the hypothalamus and have diabetes insipidus, sleep abnormalities, hyperthyroidism or diminished, thermoregulatory disorders, autonomic dysfunction, precocious puberty, hypogonadism, and personality changes. Lateral development can affect the cavernous sinus, oppress the third, fourth, and sixth pairs of cranial nerves, causing ptosis, extraocular muscle paralysis and diplopia, and can also affect the 5th pair of cranial nerves and the maxillary branch and nerves. Paralysis, abnormal feelings, etc. On the basis of tumor development, pituitary intratumoral hemorrhage can occur, called pituitary apoplexy, causing severe headache, sharp vision loss, extraocular muscle paralysis, lethargy, coma, meningeal irritation and increased intracranial pressure.

Diagnosis: detailed medical history inquiry and careful physical examination, including nervous system, fundus, vision, visual field examination, provide an important basis for the diagnosis of pituitary tumors. In addition to the pituitary large adenoma destroying the saddle bone structure, the general head X-ray examination lacks specificity. And sensitivity has been replaced by some advanced technologies. The diagnosis of pituitary tumors mainly uses imaging techniques such as CT and MRI, and its advantages have surpassed multi-directional multi-slice X-ray, angiography and cerebral angiography, etc., non-invasive and low cost. MRI can not only find microadenomas with a diameter of 3mm, but also show the structure of the hypothalamus, which is of positive value for clinical judgment of certain lesions.

Differential diagnosis

1. The vacuolar sella is due to the saddle septum defect, and the subarachnoid space extends into the saddle to enlarge the sella. Primary people are more common in obese women and multi-partum women. Secondary patients are seen in surgery, radiotherapy and trauma, infection and spontaneous necrosis of pituitary tumors, and pituitary infarction. Most patients are asymptomatic, and some may have headaches, high blood pressure, cerebrospinal fluid rhinorrhea, and a small number of pituitary hormone secretions. On the X-ray film of the lateral side of the skull, the saddle is spherical or symmetrical. The diagnosis rate of head CT was 100%, which showed that the CT value in the saddle was significantly reduced, and the density was still not seen after the enhancement.

2, saddle parasitic disease, saddle disease, infection, sarcoidosis, eosinophilic granuloma, aneurysm, meningioma, hamartoma and metastases, sometimes symptoms are easily confused with pituitary tumors, but the lesions on the saddle often have a skull Increased pressure, visual impairment, hypothalamic syndrome and hydrocephalus, general endocrine manifestations occur after neurological symptoms, CT and MRI help identify, infection, sarcoidosis and other fever and corresponding blood and immune abnormalities.

3, primary target gland hypofunction caused by pituitary enlargement Long-term primary hypothyroidism, hypogonadism can lead to negative feedback weakening, increased pituitary hormone secretion, promote hormone secretion cell proliferation, can cause slight increase in the sella Large, CT and MRI are helpful in identifying, and the improvement of the corresponding hormone replacement therapy can also help identify.

Clinical manifestations: one is the expansion of the lesions, the second is the abnormal secretion of hormones, or excessive secretion, or the tumor enlarges the normal pituitary tissue and reduces the secretion of hormones, which is characterized by secondary gonads, adrenal cortex, thyroid function. Reduced symptoms.

Space-occupying lesions of pituitary tumors can affect local and adjacent tissues. Pituitary tumors larger than 1 cm in diameter can have severe headaches due to compression of the saddle. If the development of the optic nerve is reversed, the visual field is reduced, and the visual field defect is mainly unilateral hemianopia or bilateral hemianopia. Development upwards can affect the hypothalamus and have diabetes insipidus, sleep abnormalities, hyperthyroidism or diminished, thermoregulatory disorders, autonomic dysfunction, precocious puberty, hypogonadism, and personality changes. Lateral development can affect the cavernous sinus, oppress the third, fourth, and sixth pairs of cranial nerves, causing ptosis, extraocular muscle paralysis and diplopia, and can also affect the 5th pair of cranial nerves and the maxillary branch and nerves. Paralysis, abnormal feelings, etc. On the basis of tumor development, pituitary intratumoral hemorrhage can occur, called pituitary apoplexy, causing severe headache, sharp vision loss, extraocular muscle paralysis, lethargy, coma, meningeal irritation and increased intracranial pressure.

Diagnosis: detailed medical history inquiry and careful physical examination, including nervous system, fundus, vision, visual field examination, provide an important basis for the diagnosis of pituitary tumors. In addition to the pituitary large adenoma destroying the saddle bone structure, the general head X-ray examination lacks specificity. And sensitivity has been replaced by some advanced technologies. The diagnosis of pituitary tumors mainly uses imaging techniques such as CT and MRI, and its advantages have surpassed multi-directional multi-slice X-ray, angiography and cerebral angiography, etc., non-invasive and low cost. MRI can not only find microadenomas with a diameter of 3mm, but also show the structure of the hypothalamus, which is of positive value for clinical judgment of certain lesions.

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