What is the diffuse heterogeneous structure of the pituitary gland and why is it dangerous? Structural changes in the pituitary gland

How to diagnose and treat heterogeneous pituitary gland structure

The pituitary gland is the most complex organ of the human body, which is responsible for neuroendocrine regulation. It is located at the base of the skull in the sella turcica and has three lobes that produce different hormones.

The pituitary gland, also called the medullary appendage or pituitary gland, having such tiny dimensions (its mass is only 0.5-1 g), is of great importance for the entire human body. The heterogeneous structure of the pituitary gland leads to malfunction of internal organs and systems.

This is explained by the fact that the vital hormones it produces, such as prolactin, somatotropin, glycoproteins, endorphins and others, affect the functioning of the entire human body.

Diagnostic methods

Enlargement of the pituitary gland can only be detected with tomography (CT, MRI). At the same time, the description sometimes indicates that it is the vertical size that is above the norm. This is explained by the fact that there is a horizontal bone structure that limits the growth of the organ. Therefore, such a conclusion most often occurs in temporary conditions, dysfunction of an organ with its normal structure.

If there is a tumor, the sella turcica expands in different directions, or adenoma cells fill the cavity of the sphenoid sinus if it grows downward. When moving beyond the upper boundaries, the diaphragm rises, and vision is gradually impaired. Large formations emerge from the sella turcica and compress the ventricles of the brain, cranial nerves, and blood vessels. There are cases of destruction of the bones of the base of the skull.

Patients who have an enlarged pituitary gland are recommended to donate blood for hormones. In the absence of clinical symptoms, only prolactin testing is usually necessary. If there are appropriate signs, the level of somatotropin, follicle-stimulating hormone, luteinizing hormone, corticotropin and thyrotropin is checked.

It is also important to know whether the function of target organs is altered. For this purpose, analyzes of thyroxine, cortisol, estradiol, and testosterone are indicated. It is imperative to visit an ophthalmologist to examine the fundus and evaluate the visual fields. If there are neurological symptoms (headaches, drooping eyelids, convulsions), consultation with a neurologist is necessary.

To clarify the diagnosis, tomography with the introduction of a contrast agent may be recommended if there are grounds for identifying an adenoma. Rarely, after tomography, radiography of the skull bones and angiography of the cerebral arteries are necessary.

Causes

Heterogeneity of the pituitary gland is associated with the appearance of compactions: cysts, adenoids and tumors. The formation of adenoma occurs when hormones are formed by pituitary cells. It can develop in women and men aged 25 to 50 years, and very rarely appears in children.

The cyst can be congenital or acquired and is a small bubble of fluid. Most often these are benign formations. However, if left untreated, they usually develop into malignant tumors or adenocarcinomas.

Causes of tumors in the pituitary gland

The causes of tumors in the pituitary gland are still being studied. Modern science has not yet given a clear answer to this question. However, there are several theories regarding the reasons for the enlargement of the pituitary gland:

Genetic predisposition to pituitary tumors. It can appear at any age.
Neuroinfection, the causes of such diseases, is the entry of a virus into the human body. For example, meningitis or encephalitis, both diseases are caused by the corresponding virus.
Inflammation of the anterior lobes of the brain. Chronic in nature, for example, sinusitis.
Open or closed traumatic brain injury.
Hormonal imbalance caused by taking a synthetic hormone, especially during pregnancy. That is, the impact on a person began already in the womb. The reasons for this phenomenon are the mother’s improper treatment of her thyroid gland.

Symptoms

As a rule, the disease is not felt at all. Symptoms of the abnormality may begin to appear as the tumors increase. Signs of this disease are:

Reduced field of vision and sharp deterioration of vision.
Regularly occurring headaches localized in different places.

Impaired motility of the eyeballs.
Failure of the menstrual cycle and sexual dysfunction associated with hormonal imbalance.
The appearance of neurological abnormalities: numbness, convulsions, epileptic attacks.

Circadian rhythm disturbances and poor sleep.
Loss of orientation in space.

Signs and symptoms of gland size change

If the enlargement of the pituitary gland is slight and hormonal activity is not increased, then this does not lead to clinical signs. Such changes are detected only during examination (usually with tomography) and they are not considered dangerous. If cells begin to intensively produce hormones, this manifests itself in the form of disorders.

Children's bodies and internal organs grow rapidly (gigantism). In adults, the growth zones are closed, but there may be overgrowth of the bones of the skull, feet, hands, and the nose, ears, and lower jaw become enlarged. Joint pain and headaches appear, potency in men and the menstrual cycle in women are disrupted. Diabetes, obesity, sweating, greasy skin occur, and many moles and warts appear.

Menstruation stops, the mammary glands enlarge in both sexes, and discharge from the nipples is possible. Men report weak erections and loss of sexual desire. Infertility often occurs. If the resulting hormone is inactive (large molecules), then there are no symptoms.

The thyroid gland produces thyroxine in large quantities. In patients, the heart rate and metabolic processes accelerate. They lose weight with a good appetite, become irritable, and have trouble sleeping at night. In half, the eyeballs move forward. The functioning of the testicles and ovaries is disrupted. Concerns about general weakness and low tolerance to physical activity due to shortness of breath and palpitations.

Their increase causes uterine bleeding in women, which alternates with periods of delay and irregular cycles. Miscarriage and infertility occur. In men, sexual desire and the ability to maintain an erection during sexual intercourse are impaired, and the number and motility of sperm decreases.

How is it determined

Due to the small size of the pituitary gland, it is quite difficult to detect its diffuse deviation. Ultrasound and MRI can cope with this task. Only thanks to modern techniques can one detect the degree of density of pituitary tissue and identify the fact of the development of nodes, adenomas and other neoplasms.

The result of the echocardiography of ultrasound and magnetic tomography is a description of the structure of the pituitary gland. The result of the study is considered positive, the conclusion of which is “the echostructure of the pituitary gland is homogeneous, without changes.”

Microadenomas on MRI images

The small size of the tumor makes it difficult to diagnose; such processes can be asymptomatic. But identifying a tumor in the early stages increases the chances of successful treatment and a favorable prognosis in the future.

Magnetic resonance examination allows you to see altered areas and identify microadenomas whose size does not exceed 10 mm. The cystic form is distinguished by the presence of clear boundaries; on MRI, such tumors appear and appear as a dark spot on the images.

Other research methods are ineffective in this case. Thanks to MRI of the brain, cystic microadenoma is differentiated from other processes that have similar signs:

craniopharyngioma;
archanoid cyst;
cystic process of Rathke's pouch.

The method determines the disease and helps to predict the consequences of tumor development, which depend on the location of the lesion.

Rathke's pouch cyst on MRI

Consequences of the heterogeneous structure of the pituitary gland

The structure becomes heterogeneous from the moment of formation of various compactions. The consequences of this condition of the pituitary gland depend on the cause of its occurrence, the degree and volume of malignancy.

A patient with the smallest formations (the size of the adenoids varies up to 10 mm) experiences virtually no discomfort, or it only manifests itself for a short time.

As tumors grow, the following symptoms may occur:

Rapid deterioration of vision and even complete loss of vision;
Dizziness and loss of coordination;
Numbness of the limbs;
Epilepsy attacks;
Disorders of the reproductive and reproductive systems.

In the case of rapid growth of malignant tumors, the patient is given a disappointing prognosis. Most often, people with hypertension, excess weight, and diabetics are at risk. Diffuse changes in the pituitary gland most have negative consequences for the reproductive system of the body.

So, for women this is a disruption in the menstrual cycle and problematic conception. Men with this diagnosis experience erectile dysfunction.

Symptoms of tumors in the pituitary gland

Symptoms of the appearance of tumors in the pituitary gland depend on what type of cells the neoplasm consists of and whether the synthesis of hormones continues on the surface affected by the tumor.

If a tumor that does not produce the hormone grows, it gradually begins to put pressure on the adjacent lobes of the brain, causing a number of manifestations of various kinds. And the more the tumor increases pressure, the brighter the symptoms become:

Visual impairment. It is caused by swelling of the optic nerve; peripheral vision first disappears, then the clarity of the image decreases and, ultimately, blindness occurs.
When the nerves in the brain are compressed, nystagmus develops - involuntary twitching of the eyeball, ptosis - drooping of the eyelid, and eventually complete paralysis of the eyeball occurs.
A person begins to have a headache often and quite severely.
Heart failure develops.
Chronically increased intracranial pressure occurs, often due to bleeding in the pituitary gland.
When the tumor grows to such a state that it penetrates the hypothalamus, the patient begins to regularly lose consciousness.

If the tumor continues to produce some hormone, then the hormonal imbalance manifests itself much earlier than the symptoms of tumor growth and pressure on the brain.

That is, the presence of a tumor in the pituitary gland is manifested by external signs in the patient’s appearance. Somatotropin-producing adenomas cause acromegaly. At the same time, the patient’s bones thicken, his tongue, nose, ears become enlarged, or his height simply increases significantly. Tumors that produce prolactin are manifested by the absence of menstruation, in men the mammary glands become enlarged and milk may even appear.

The increasing volume of ACTH released by the tumor is accompanied by a fairly large list of symptoms:

first of all, this is a dysfunction of the reproductive system;
then the body deposits fat in the face and hips, making the person’s figure and face characteristic in appearance;
the muscles in the legs and arms weaken, sometimes to the point of complete atrophy;
the skin becomes pale and dry;
Women begin to grow facial hair;
men become completely impotent;
the bone structure becomes weak and large, usually accompanied by multiple fractures;
blood pressure rises;
the patient has an increased heart rate;
a change in the psyche occurs - depression is replaced by euphoria, behavioral inhibition sets in.

Adenomas that continue to increase thyrotropin cause disruption of the thyroid gland. As a result, a number of characteristic symptoms arise:

perspiration is disrupted, the patient begins to suffer from constipation;
the patient gains excess weight;
becomes inhibited and emotionally inactive;
the skin becomes dry and hair falls out;
the eyeballs “roll out” from their sockets, giving the face a characteristic appearance;
cardiovascular failure develops;
metabolism is disrupted.

How to diagnose correctly

The appearance of neurological symptoms is not 100% a consequence of the heterogeneous structure of the pituitary gland. To exclude other causes of illness, it is necessary to undergo several diagnostic procedures:

Radioimmunological testing of blood, revealing the level of hormones in it.
Ultrasound. This is a primary procedure especially for newborn babies.
Magnetic resonance imaging. In modern medicine, this is the most informative method of diagnosis. Allows you to detect compactions measuring only a few millimeters in the heterogeneous structure of the organ.

If the development of malignant tumors is suspected, examination on a tomograph using a marker is necessary. This procedure helps to identify the nature of the tumor.

How to prepare for an MRI of the pituitary gland

The magnetic resonance imaging procedure does not require special preparation. The patient needs to warn the doctor about the presence of metal prostheses, implants, implanted electrical devices and pacemakers. Before the examination, remove outer clothing and accessories.

To increase the information content of the method, MRI is performed with intravenous administration of a contrast agent. In this case, you need to make sure that the solution used is tolerable. Patients prone to allergic reactions should warn their doctor.

Before the procedure, the doctor conducts a conversation, explains how the examination is carried out, how long it takes. Reminds you to remain still during scanning. Following the specialist’s recommendations affects the quality of the image and the diagnosis.

Therapy methods

Often, it is possible to diagnose a heterogeneous structure only in a situation where the grown compactions begin to affect neighboring tissues. To select the correct treatment, the doctor needs to study the results of all tests, and the patient must undergo a tomography examination.

If the volume of the compaction is small, as a rule, regular monitoring of its increase is prescribed. If there is no tendency for tumor cells to grow, there is no need for drug treatment.

Medication therapy should only be prescribed by the attending physician. With the right blocking treatment, many of the consequences of the disease are suspended and even eliminated: potency and reproductive abilities can be restored.

Treatment of enlarged pituitary gland

If there are no visual impairments and abnormalities in blood tests for hormones, then an enlargement of the pituitary gland requires only observation. Patients are prescribed tomography and repeated blood tests, examination by a neurologist and an ophthalmologist once a year. If an adenoma is detected, then depending on its size and hormonal activity, the doctor chooses treatment tactics:

removal through the nasal passages (endonasal transsphenoidal adenomectomy) – performed when there is an increased level of hormones with corresponding symptoms, signs of compression of the optic nerves, high intracranial pressure;
surgery with opening of the skull - a large tumor that cannot be removed by endonasal access, since there is a possibility of damage to neighboring brain structures.
radiation therapy is prescribed for inactive tumors (does not produce hormones), for elderly patients, or for contraindications to surgery; radiation is also indicated after surgical removal of a large adenoma;
cryodestruction - inserting a probe through the nasal passage into the pituitary gland and applying cold to it to destroy the tumor;
medications - somatostatin, which suppresses the formation of growth hormone, Parlodel and Dostinex for high prolactin, Peritol to inhibit cells that produce corticotropin and somatotropin.

What is the diffuse heterogeneous structure of the pituitary gland and why is it dangerous?

What does diffuse tissue heterogeneity mean? Why does the pituitary gland have a heterogeneous structure?
Signs of a heterogeneous structure of the pituitary gland
Why is diffuse heterogeneity scary?

How to treat a diffusely heterogeneous structure

What examinations need to be done

The pituitary gland, or pituitary gland, plays an important role in the functioning of the body, producing most of the vital hormones. In a normal state, the lower part of the brain, closely connected to the hypothalamus, successfully adapts to the needs of the human body, increasing or decreasing the amount of hormones produced as necessary.

Failures in the neuroendocrine complex lead to problems in the functioning of the internal systems of the body. The diffusely heterogeneous structure of the pituitary gland is a clinical manifestation of disorders that affects the tissues of the gland.

Indications for MRI of the pituitary gland

The most common pathology of the pituitary gland is an adenoma - a benign tumor that disrupts the secretion of necessary hormones. The localization of the tumor determines the clinical picture. Indications for MRI of the pituitary gland are:

hypersecretion of endocrine glands of unknown etiology;
menstrual irregularities;
causeless secretion of milk from the mammary glands;
suspicion of Itsenko-Cushing syndrome;
decreased vision;
thyroid dysfunction;
disturbances in the functioning of the adrenal cortex;
headaches, migraine;
depressive states;
sleep disturbance of unknown etiology;
weight fluctuations for no apparent reason;
disturbances in growth and development of the body;
delayed psycho-emotional development in children;
infertility;
signs of acromegaly;
erectile disfunction.

Disturbances in the functioning of the pituitary gland affect the entire body, causing a response from the cardiovascular system, digestive organs, and central nervous system. Diseases of the gland are accompanied by changes in its structure, shape and size, which is clearly visible as a result of MRI.

MRI image of a pituitary adenoma

What does diffuse tissue heterogeneity mean?

The pituitary gland is small in size and weighs only 0.5-1 g. To determine any abnormalities, an ultrasound or tomography is required. The results of the examination may indicate that the structure of the pituitary gland during the study is diffusely heterogeneous. What does this diagnosis mean?

Why does the pituitary gland have a heterogeneous structure?

The diagnosis is diffuse tissue heterogeneity, indicating unequal reflective properties of tissues. The reasons for this are:

Adenomas.
Cystic formations.
Tumors.

Consequently, the structural heterogeneity of the pituitary gland means that in some areas the tissue has compactions. In most cases, we are talking about benign education. But in the absence of proper treatment, tissue degeneration and the formation of adenocarcinoma, a malignant tumor, are possible. This happens extremely rarely, but the danger of degeneration still exists.

Signs of a heterogeneous structure of the pituitary gland

The main symptoms of the disease are:

A sharp deterioration in vision - first the field of vision decreases. When visiting an ophthalmologist, a deterioration in the motility of the eyeball is detected.
Headaches are not relieved by conventional analgesics.
Neurological signs - a large tumor leads to the appearance of convulsions, numbness, and epileptic seizures.
Changes in hormonal levels - the consequence of heterogeneity of pituitary gland tissue is sexual dysfunction, menstrual irregularities, and inability to become pregnant.

Additional signs indicating that there is heterogeneity of the pituitary gland are disturbances in a person’s circadian rhythms, insomnia, and in severe cases, loss of orientation in space.

Why is diffuse heterogeneity scary?

The heterogeneous structure of the pituitary gland indicates that a tumor is developing in the area of the pituitary gland. The consequences of the development of the resulting anomaly depend on its nature, volume and degree of malignancy.

With a small size of the formation, diffuse heterogeneity practically does not cause concern to the patient. Symptomatic manifestations, if observed, are short-term.

The result of further tumor enlargement is:

Disturbances in human hormonal levels.
Dysfunction of the reproductive and reproductive systems.
Deterioration of visual function, up to partial or complete loss of vision.
Neurological manifestations: epileptic seizures, loss of coordination, paralysis of limbs, dizziness.

The reason for the heterogeneity of the structure of the lower cerebral appendage may be a rapidly growing malignant neoplasm. In this case, the patient’s disease has an unfavorable prognosis.

Diffuse heterogeneous changes in the structure of the pituitary gland have a particularly strong effect on the human reproductive system. In women, the pathology manifests itself in the disruption of the menstrual cycle and the inability to become pregnant. Men suffer from excess weight and erectile dysfunction.

In childhood, a diffusely heterogeneous structure is associated with dwarfism and gigantism.

Increase in the vertical size of the pituitary gland

Causes of tumor formations

There is still no clear answer to what causes the enlargement of the part of the brain in question. Theoretically, the cause of the tumor could be:

predisposition to tumor;
infections caused by viruses;
chronic inflammation of the frontal and temporal lobes;
closed and open traumatic brain injury;
hormonal imbalance due to taking a synthetic hormone.

Signs of a tumor

As a non-hormone-producing tumor enlarges, there is pressure on the lobes of the brain, which leads to the following symptoms:

Visual disturbances due to swelling of the optic nerve, which can lead to blindness.
Involuntary eye twitching, and in some cases complete paralysis.
Headache.
Heart failure.
Increased blood pressure, often accompanied by bleeding in the pituitary gland.
Regular loss of consciousness due to the penetration of an enlarging tumor into the hypothalamus.

If the malignant tumor still produces one or another hormone, then the hormonal imbalance will make itself felt even before the tumor begins to put pressure on the brain.

The presence of a tumor can be determined by the patient's unhealthy appearance. His bones thicken, his organs (ears, nose, tongue) or height increase. In women, prolactin may not menstruate; in men, the mammary glands may become enlarged.

An increasing ACTH volume is accompanied by the following symptoms:

impaired functioning of the reproductive system;
fat deposits in the thighs and face;
atrophy of the muscles of the arms and legs;
pale and dry skin;
facial hair grows in women;
impotence;
weakening and brittleness of bones;
high blood pressure;
accelerated heartbeat;
depression followed by euphoria;
inhibited reaction.

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Adenomas contribute to a further increase in thyrotropin, causing functional malfunctions of the thyroid gland. As a result:

constipation appears;
weight increases;
inhibition is observed;
hair falls out and skin becomes dry;
cardiovascular failure develops;
metabolic disorders are observed.

Diagnostics

Diagnostics are carried out by a number of specialists. For example, an ophthalmologist assesses the quality of vision and examines the fundus of the eye. The endocrinologist, based on blood tests, assesses how significant the hormonal imbalance is - determines the missing hormones and those that are in excess in the body. A neurologist studies the brain using radiography and various types of tomography (computer and magnetic resonance imaging). If necessary, angiography is performed to analyze the functioning of the brain vessels.

Treatment

As a rule, patients with the disease in question are treated surgically, without affecting the medulla, since the pituitary gland is penetrated through the sphenoid bone. The operation is carried out under the supervision of a neurosurgeon, after which the patient is sent to an endocrinologist for long-term therapy with hormonal drugs.

Radiation therapy is carried out in case of inoperable tumor formations. Sometimes cryodestruction is used to freeze and destroy the tumor, in which a small puncture is made in the bone and a thin instrument is inserted into the pituitary gland.

If surgery is impossible in principle, then treatment with synthetic hormones or their substitutes is prescribed, but such therapy is only a temporary measure and is used when preparing patients for operations or after them.

Prevention of pituitary tumors

Radiation therapy for brain tumors

To avoid illness, you need to follow safety precautions - wear a hard hat or helmet at work and other places where it is recommended.

Also, you should not take hormonal medications without consulting your doctor.

It is recommended to undergo a full examination in the hospital, which will allow the tumor to be diagnosed at an early stage.

What is the diffuse-heterogeneous structure of the pituitary gland

4 minutes to read

A diffusely heterogeneous structure of the pituitary gland is a clinical phenomenon that indicates a malfunction of the neuroendocrine system. The pituitary gland works in tandem with the hypothalamus, forming the hypothalamic-pituitary system. It regulates the functioning of all organs with the help of hormones. When the structure of the pituitary gland changes, the functioning of this system is disrupted. This change can only be seen on an MRI (magnetic resonance imaging).

Content

Functions of the pituitary gland

The human brain has a rather complex anatomical structure. Each section of the central nervous system is connected to each other through synaptic connections (propagation and transmission of signals along the nerve fiber), which allows regulating the functioning of the entire organism.

What is the pituitary gland? It is a small process that is located in the lower cerebral appendage. Despite its small size (from 5 to 13 mm), the gland has lobes that consist of different tissues and produce their own hormones.

The front is the most massive part. The adenohypophysis in the brain is represented by glandular endocrine cells;
Intermediate - is a thin layer of hormone cells between the lobes;
Posterior - represented by nervous tissue and the connective funnel. The neurohypophysis forms the stalk of the gland.

The pituitary gland closely interacts with the nuclei of the hypothalamus and acts as a storehouse of hormones. The combination of structures (hypothalamic-pituitary system) is responsible for the functioning of the peripheral endocrine glands.

Regulation of thyroid hormones;
Stimulation of the adrenal cortex;
Regulation of the female reproductive system;
Stimulation of body growth;
Regulation of metabolic processes;
Regulation of lactation.

The anterior lobe stimulates a specific gland. An increase in the level of the hormone in the blood suppresses its secretion in the pituitary gland (feedback principle).

The functions of the middle lobe are to stimulate and secrete melanin (responsible for pigment). Hormones of the intermediate part of the pituitary gland are regulated by reflex actions (light entering the retina).

Blood pressure regulation;
Control of water balance in the body;
Formation of emotional connections;
Reduction of myoepithelial cells.

The pituitary gland in the brain is almost completely controlled by the hypothalamus, regulating its action on the endocrine glands and the entire body. The pituitary gland communicates with the cortex and other parts of the brain through the subcortical nodes (grouped nuclei of gray matter).

What it is

The pituitary gland is also called the pituitary gland, which is located on the lower surface of the brain. The mass of the gland is only 1 g. Not only the functioning of the internal organs, but also the appearance of a person depends on its work.

It is she who ensures the development of universal human external characteristics. Therefore, deviations in its work will be very noticeable.

To examine the pituitary gland, an MRI is performed, which determines the homogeneity of the tissue, that is, the ability to equally reflect rays.

By homogeneity we mean:

absence of pathological shadows;
maintaining normal sizes ;
smooth borders with smooth curves;
no signs of infiltration;
position of the organ relative to other tissues.

If there is a discrepancy with even one point, we can talk about the diagnosis of diffuse heterogeneity of the pituitary gland.

Treatment of tumors in the pituitary gland

After diagnosing a tumor, they usually do not wonder why it appeared, but rather decide how to remove it. In most cases, surgery is done. The medulla is not affected, since penetration into the pituitary gland is carried out through the sphenoid bone. The operation is performed by a neurosurgeon, and after it the patient is taken by an endocrinologist, since the postoperative period involves a long period of treatment with hormonal drugs.

Radiation therapy is used if the tumor is inoperable, that is, it cannot be approached in the usual way. In some cases, cryodestruction is used. This procedure allows you to freeze the tumor and then destroy it. This operation allows you to get by with a small puncture in the bone, since the instrument inserted into the pituitary gland is very thin.

If the operation cannot be performed in principle, then the patient is treated with medications. But such treatment is not effective and is taken as a temporary measure when preparing the patient for surgery or after it. The course of treatment usually includes drugs with synthetic hormones or substances that replace them.

Symptoms

With small focal changes in the tissue, symptoms may be absent or have minor manifestations. But such foci can degenerate, acquiring a malignant course, unite into larger foci (merge) or disappear completely.

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Symptoms indicating a malfunction of the pituitary gland:

-type headaches : debilitating diffuse headache of a pulsating nature, taking antispasmodics does not help, and painkillers bring temporary improvement;
deterioration of vision: changes in visual fields up to the formation of a tunnel, decreased ability to focus the gaze;
the appearance of isolated episodes of minor epileptic seizures;
changes in hormonal levels - laboratory parameters of prolactin, thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH) are increased several times.

It is also possible to have a disturbance in circadian rhythms, episodes of insomnia, and a disturbance in spatial orientation. In women, hair growth may increase and change to a male type.

The principle of operation of the endocrine gland

The pituitary gland is a gland in the brain that is capable of producing hormones that are synthesized by the cells of the anterior lobe. With their help, the pituitary gland directly changes:

body growth - somatotropin, or somatotropic hormone, is responsible for increasing the size of the child’s body and internal organs;
lactation - prolactin helps the formation of breast milk, and outside of pregnancy and in men it regulates the functioning of the reproductive system.

All other hormones of the anterior lobe act through the glands:

thyroid - thyrotropin causes the formation of thyroxine and triiodothyronine, which increase the metabolic rate;
adrenal glands – adrenocorticotropic hormone promotes the production of cortisol, slightly increases the production of sex steroids and aldosterone (retains sodium and water, removes potassium);
sexual - gonadotropins (follicle-stimulating and luteinizing hormones) are responsible for the functioning of the ovaries, testes, fertilization processes, the formation of female hormones (estradiol, progesterone) and male (testosterone).

The posterior lobe of the pituitary gland serves as a reservoir for hormones coming from the hypothalamus - oxytocin and vasopressin. The first is needed to contract the uterus and milk ducts. The second is also called antidiuretic, that is, it prevents diuresis - the release of urine by the kidneys.

The pituitary gland is located in a bony cavity that looks like a bowl. It is called the sella turcica. This gland is connected to the hypothalamus via a funnel. Their close location and hormonal connection make it possible to combine them into one center for the regulation of the endocrine system.

The hypothalamic nuclei analyze the composition of the blood and give commands to the pituitary gland to strengthen or inhibit the work of target organs (adrenal glands, thyroid gland, testes, ovaries). This is how the constancy of all basic vital parameters is normally maintained.

And here is more information about pituitary gland disorders.

Diagnostics

All patients with suspected diffuse changes in the pituitary gland are examined according to a single plan, which includes sequential clinical, laboratory and instrumental methods.

Clinical diagnosis

First, the specialist collects complaints. Then it checks visual acuity, changes in its fields, the condition of the fundus and the presence of oculomotor disorders. Then a neurological examination, which consists of an assessment of reflexes and speech contact.

Laboratory methods

General blood and urine tests are prescribed, as well as a biochemical analysis of blood and the functioning of the coagulation system. After this, a radioimmune study of hormones in the blood.

prolactin;
somatotropic hormone (STH);
adrenocorticotropic (ACTH);
thyroid stimulating (TSH);
somatomedin;
triiodothyronine (T3);
thyroxine (T4);
cortisol;
sex hormones.

Instrumental methods

When examining the pituitary gland, MRI and ultrasound (ultrasound) are mainly used. However, MRI remains more informative. His work is based on reading the tissue reflection of magnetic waves that he himself creates. He takes layer-by-layer photographs, allowing you to see the sections.

Ultrasound is based on the ability of ultrasound beams to penetrate tissue. This method is safer in terms of radiation exposure. But with such a study, all rays from all organ tissues that cover the object under study are superimposed.

Undoubtedly, there are ways to examine only one organ, for example, the special position of the patient during the procedure. But ultrasound is used as an additional diagnostic method.

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X-ray examination is also used as an additional method. Lateral craniography is performed and the condition of the sella turcica is assessed.

It is a bony structure in the cranial cavity that contains the pituitary gland. Its size, changes in structure, and elements of bone tissue destruction are assessed.

Treatment

After examining the patient, a treatment method is chosen. It consists only of observation when:

there are no neurological symptoms;
no ophthalmological disorders;
a hormonally inactive form of change in the pituitary gland.

In this case, the patient is registered with an endocrinologist, ophthalmologist and neurosurgeon and undergoes a preventive examination with them once a year.

In other cases, the issue of surgical treatment of the pituitary gland or a conservative method is decided.

Surgical methods

All causes of diffusely heterogeneous structure of the pituitary gland are amenable to surgical treatment. There are two methods in total - endoscopic intervention through the nasal sinuses and microsurgical interventions in the brain area.

The difference is that in the first case, a full tissue incision is not required. Therefore, up to 80-90% of all operations are tried to be carried out using this method.

Conservative treatment

Conservative treatment means the use of medications. The scheme is drawn up taking into account the solution of the following problems:

Increased concentrations of certain hormones. In this case, everything depends on the type of diffuse change in the pituitary gland. For example, for somatotropin-producing adenomas, agonists of receptors sensitive to this hormone are prescribed. This leads to the fact that growth hormone does not interact with them and does not activate cell function.

Replenishment of hormone deficiency. Hormone replacement therapy is used.

Causes of pituitary gland enlargement

If there is not enough of a hormone in the blood, the hypothalamus begins to stimulate the cells of the pituitary gland. For example, during menopause, the formation of female hormones estrogen in the ovaries decreased.

Due to hard work, the gland may increase in size. The same mechanism underlies changes in deficiency:

thyroid hormones – hypothyroidism caused by iodine deficiency, irradiation or organ removal;
adrenal cortisol – decreases with autoimmune inflammation (antibodies are formed to one’s own cells), tuberculosis, genetic diseases;
sex hormones – diseases of the testicles, ovaries, long-term use of hormonal contraceptives.

Temporary enlargement of the gland is typical during pregnancy. Since only during this period a large amount of prolactin is required, the cells that produce it grow. Persistent changes in the pituitary gland occur after removal of the endocrine glands (thyroid, reproductive, adrenal glands), during irradiation or tumor destruction.

Complications

Diffuse heterogeneous changes in the pituitary gland can lead to complications such as:

hormonal imbalance ;
when enlarges, compression of nearby structures occurs;
cerebral ischemia
development of epilepsy;
progression of visual up to blindness;
development of diabetes mellitus;
changes in the structure of other endocrine organs.

Hyperplastic changes during pregnancy

Noticeable hyperplastic changes in the pituitary gland can be detected during pregnancy (usually repeated). In this case, the pituitary gland can take on a rounded shape and protrude slightly above the area of the sella turcica. The pituitary tissue becomes grayish-white in color. During the first pregnancy, the pituitary gland can increase up to 0.75 g, during repeated ones - 1.0 g or more. The mechanism of development of hyperplasia of pituitary tissue during pregnancy is the formation of large cells with protoplasm, densely colored, from the main cells. After delivery, large cells are again modified into main cells, but some of them die. In women who have given birth repeatedly, these “pregnant cells” are represented by wide cords of compactly located cells. Microscopically, these changes may be mistaken for an adenoma.

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Forecast

With minor changes, the prognosis is favorable. Most pathologies of the pituitary gland are treatable, and replacement therapy allows you to avoid side diseases.

Poor prognosis for large malignant tumors with elements of ischemia and local bleeding.

But when assessing the prognosis, it is also important to take into account age, concomitant diseases and the degree of their compensation. Do not forget that the course of the disease depends on the psycho-emotional background of the patient and his desires.

Possible complications and pathologies

But, unfortunately, sometimes such a conclusion will indicate pathology:

An extremely rare variant of autoimmune endocrinopathy, in which three diseases develop simultaneously - autoimmune damage to the thyroid gland, diabetes insipidus and autoimmune hypophysitis. With these diseases, the body's own cells begin to attack their own fellow cells, considering them to be strangers. The disease is often hereditary. Complete recovery from these diseases is impossible. But high doses of glucocorticoids can stop the process.
Vertical growth of the tumor - this will also increase the vertical size of the pituitary gland. Treatment tactics in this case will be wait-and-see and depend on the rate of tumor growth. If signs of pressure on the optic chiasm appear, surgical treatment is resorted to.

In any case, if you received an unclear diagnosis on your MRI, there is no need to panic. Contact a specialist for clarification and remember - with timely diagnosis and treatment, most diseases can be overcome!

Author of the article: doctor Gural Tamara Sergeevna.