Any pituitary adenoma (or any other tumor or disease affecting the pituitary region, for that matter) can cause headaches. The headaches may vary from mild to severe, and the severity is not always proportional to tumor size. The headaches are commonly retro-orbital but may be more generalized and can be mistaken for other types of headaches, such as tension or migraine headaches. Because these tumors usually grow slowly and can become quite large before they are discovered, the headaches are often present for many years. On the other hand, some patients with very large tumors are surprisingly free of headaches. Rarely, patients will have sudden onset of a severe headache or give a history of a severe headache that spontaneously resolved. Such a history raises the possibility of acute hemorrhage or infarction of the tumor.
Another common symptom caused by the size and location of the tumor is decreased vision. This usually presents as temporal visual field defects, although other visual field loss may also occur. It is caused by the tumor growing upward out of the sella and pressing on the optic chiasm. The decrease in peripheral vision may be quite extensive without the patient realizing it, because people tend to rely on central, rather than peripheral, vision for most daily activities. Other less common vision complaints include diplopia. This results from the tumor extending laterally into the cavernous sinus and compressing the cranial nerves controlling extraocular muscle function.
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