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Recent News and Articles on the Keywords: pineal tumors + pineal + tumor  Related to the article below (Last Update: 8/5/2008)

Pineal Tumors

Tumors in the region of the pineal gland account for about one percent of brain tumors. Many different types of tumors with completely different characteristics occur in this region, but the most common type is called a germinoma.

When pineal tumors occur in childhood, they can produce an early puberty, especially in boys. This type of tumor causes pressure in the channel that connects two cavities of the brain where fluid flows around the brain and spinal cord. The tumor can cause pressure inside the brain (leading to hydrocephalus), swelling inside the eye and vomiting. It can also cause paralysis of the upward gaze, sagging or drooping of the upper eyelid and a loss of reflex reactions in the eye.

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Pineal tumors can occur at any age, but they are most common in childhood.

A neurologic evaluation should be done if a patient has slowly increasing signs of mental dysfunction, new seizures, persistent headaches or evidence that there is pressure inside the skull (such as vomiting or swelling or protrusion of the blind spot at the back of the eye). A neurologist (a doctor who has received special additional training in the diagnosis and treatment of disorders of the brain, spinal cord and nerves) will perform a complete examination.

He or she may also request that a magnetic resonance imaging (MRI) scan or a computed tomography (CT or CAT) scan be done, as well as chest X-rays, to determine if the tumor has spread from another part of the body. An MRI usually finds low-grade astrocytomas earlier than CT. Cerebral angiography is rarely used to diagnose a brain tumor, but it may be done before surgery.

Depending on the patient's symptoms, specialized tests may be done, including tests of the field of vision, the sharpness of vision and hearing. If the results of other tests are not conclusive, an examination of the fluid that surrounds the brain and spinal cord may be done, although it is usually unnecessary. It is essential for diagnosing chronic or subacute meningitis or for identifying benign hypertension inside the skull.

Treatment of a brain tumor depends on the nature of the tumor, how rapidly it is growing, what symptoms it is causing and where it is located. Several treatment approaches may be used. Surgery is usually done to make a diagnosis and to improve symptoms. This may be enough to cure benign tumors.

Radiation therapy is required to treat gliomas. Radiation therapy may also be beneficial in the short-term for tumors that have spread from other parts of the body. Chemotherapy also benefits some patients with such tumors.

The pituitary gland is a small oval gland at the base of the brain. It controls most of our hormones. These control thyroid activity, the monthly cycle in women, sex drive, growth in children, adrenal gland activity, urine output, the start childbirth and milk-production after pregnancy.

Doctors describe these tumors in several ways. One is as:

• Secreting, which release hormones. These can trigger symptoms such as impotence, stopping of a woman's monthly periods, galactorrhea, abnormal body growth, Cushing's syndrome or hyperthyroidism.
  
• Non-secreting, which are usually larger when found and treated with surgery and radiation therapy.
  

Another is by size:

• Microadenomas, which are smaller than one centimeter
  
• Macroadenomas, which are larger than one centimeter. These can be quite large if not found until they affect nearby brain tissues. The optic nerves are particularly vulnerable. Early on, the vision at the edges of the field of sight can be affected. Pituitary tumors can spread into the area of the head that contains the carotid artery and cranial nerves. When this occurs, the tumors may be particularly difficult to completely remove.
  

Symptoms vary based on the tumor's size, where it is and whether it secretes or not. They may include:

• Overproduction of hormones. Functional tumors, which secrete hormones, can produce too much hormones. Almost 20% secrete prolactin, a hormone that causes milk production in women. Very high levels can cause milk production in men and women who are not pregnant. Menstrual irregularities may also occur.
  
• Underproduction of hormones. Some 75% of pituitary tumors don't produce hormones. These can grow and damage normal gland tissue. This cuts hormone production. Often the first hormones affected are those that relate to sex. This can cause irregularity or loss of menstruation in women and sterility with loss of sex drive in men and women.
  
• Growth disorders. These cause excessive growth (gigantism) in children. In adults, they cause acromegaly, or abnormal growth of the face bones, enlarged hands and feet, excessive sweating and heart disease.
  
• Disturbances in vision will occur if the tumor presses on the optic nerves.
  

A magnetic resonance imaging (MRI) scan is the most sensitive test for pituitary tumors. It can rapidly show even small tumors. Sometimes computed tomography (CT) scanning is used. However, this may not detect small tumors.

Complete hormone testing is also important. An endocrinologist may need to be consulted. A complete neurological evaluation, including a visual field exam, is also needed to see if there is any visual loss.

Treatment is set by the size of the tumor and the patient's symptoms and hormone status. Reducing pressure on nearby structures (generally the optic nerves) and restoring normal hormone production is important.

Treatment may include:

• Observation and monitoring with MRI scans and visual field studies, if the patient's vision is not threatened and hormone production is normal
  
• Surgery
• Stereotactic radiosurgery
• Radiation therapy
• Drugs