Pituitary tumors

When it’s functioning normally, the pituitary gland controls the production of important hormones. The hormones normally secreted by the pituitary gland include:

• Adrenocorticotropic hormone (ACTH): Regulates cortisone and the stress response system.
• Antidiuretic hormone (ADH): Helps the body maintain water and constrict blood vessels.
• Human growth hormone (HGH): Stimulates the growth of cells.
• Luteinizing hormone/follicle stimulating hormone: Regulate the female reproductive system.
• Oxytocin: Causes uterine contractions during pregnancy and childbirth and supports lactation (milk production) after birth.
• Prolactin: Stimulates lactation and regulates the reproductive system.
• Thyroid stimulating hormone (TSH): Affects metabolism.

When a pituitary gland tumor forms, it can lead to either low levels or high levels of any of these hormones. Both effects are harmful for your body.

Types of pituitary tumors

Some pituitary tumors secrete excess hormones and are called functioning tumors. Other pituitary tumors don’t secrete excess hormones and are called nonfunctioning pituitary tumors.

Prolactinomas – functioning pituitary adenomas that secrete excess prolactin – are the most common type of pituitary adenoma.

Cancerous pituitary tumors

Not much is known about cancerous pituitary tumors because they’re very rare. Fewer than 0.1% of pituitary tumors are cancerous. Other names for cancerous pituitary tumors are:

• Pituitary carcinomas
• Metastatic pituitary neuroendocrine tumors (PitNETs)

Pituitary carcinomas may spread into the brain or spine. Sometimes they spread to other areas of the body. They’re more common in older people, although they can occur at any age.

Pituitary carcinomas are almost always functioning tumors.

Pituitary tumor symptoms

Nonfunctioning pituitary tumor symptoms depend mostly on their size and location. They usually cause pituitary adenoma symptoms when they put too much pressure on the pituitary gland or on the brain, which is near the pituitary. Nonfunctioning pituitary adenoma symptoms may include:

• Blindness that comes on gradually
• Blurred or double vision
• Dizziness
• Facial pain or numbness
• Headaches
• Loss of consciousness
• Loss of peripheral vision

When nonfunctioning tumors grow larger, they may damage parts of the pituitary gland, which makes it stop producing normal amounts of hormones. This condition is called hypopituitarism and can cause pituitary tumor symptoms such as:

• Erectile dysfunction (trouble with erections) in men
• Feeling cold
• Feeling tired or weak
• Loss of body hair
• Low blood pressure
• Menstrual changes or loss of menstrual periods in women
• Unexplained weight loss or weight gain

Symptoms of functioning pituitary adenomas

The symptoms of functioning pituitary tumors vary according to the hormone secreted by the tumor. If a tumor secretes excess human growth hormones in a child, they may grow to be exceptionally tall and have large hands and feet.

Complications of pituitary adenomas

It’s important to identify and treat functioning pituitary tumors promptly before they cause complications such as:

• Blindness
• Cardiovascular disease
• Diabetes
• High blood pressure
• Hormone deficiencies
• Kidney stones
• Weakened bones (osteoporosis)

Pituitary apoplexy is a rare, but very serious complication of a pituitary adenoma. It means there is bleeding either into or out of your pituitary gland and it can be life-threatening. Symptoms of pituitary apoplexy are:

• Loss of peripheral vision or of all vision in one or both eyes
• Low blood pressure, nausea and vomiting
• Paralysis of the eye muscles
• Personality changes
• Severe headache

If someone has symptoms of pituitary apoplexy, call 911 or seek emergency care as soon as possible.

Diagnosis of pituitary tumors

Your doctor will decide on a diagnosis based on the potential pituitary tumor symptoms you report and on the signs they discover through a physical exam and testing. Some of the tests they may order include:

• Blood and urine tests to measure hormone and blood sugar levels.
• Inferior petrosal sinus sampling, in which blood samples are taken from the pituitary and tested to determine if a tumor could be causing the symptoms.
• MRI and CT scans to show if a tumor is present.
• Vision screening to see if your eyesight has been affected.

Some benign pituitary tumors are only discovered when a person has had brain imaging tests done for some other reason. It’s possible to live your whole life with a benign pituitary tumor and never find out about it.

Pituitary tumor vs. craniopharyngioma

Pituitary tumors and craniopharyngiomas are both primary brain tumors according to the medical community, even though they don’t grow in brain tissue. However, craniopharyngiomas are very rare and grow near the pituitary gland instead of in it. Craniopharyngiomas are always benign.

Both kinds of tumors can cause symptoms and become dangerous if they grow to be too big. Your doctor will diagnose your brain tumor based on testing and the location of the tumor.

Pituitary tumor treatments

Treatment for a pituitary tumor will come from a multidisciplinary team that may include neurologists, neurosurgeons, endocrinologists, radiation oncologists, and an ear, nose and throat surgeon.

The first course of treatment for a functioning pituitary tumor may be medications to reduce levels of whatever hormones are being produced by the tumor. Medications can be very effective at shrinking tumors and stopping them from producing excess hormones.

If medications don’t work well enough or if your tumor is nonfunctioning, you may receive a combination of surgical and nonsurgical treatments.

Pituitary tumor surgery

Different types of surgery are used to remove pituitary tumors depending on their size and location.

For pituitary tumor surgery, surgeons often use a transsphenoidal approach – a minimally invasive technique which involves inserting tools through the nasal passages and sinuses. Since this technique doesn’t require an incision, you’ll have a quicker recovery, no visible scar and less likelihood of complications.

Some pituitary tumors require a craniotomy surgery, which involves removing a small piece of the skull to reach the tumor. After the surgery is done, the surgeon replaces the piece of skull while closing the incision.

When surgery succeeds in removing the whole tumor, you may be considered cured and won’t need any other treatments. For some people, the tumor won’t be removed completely, or it may slowly grow back.

Risks of pituitary gland tumor surgery

Surgery to remove a pituitary tumor is generally safe. If complications happen, they may include:

• Bleeding
• Brain injury
• Damage to the pituitary gland
• Double vision or loss of vision
• Infection
• Leakage of cerebrospinal fluid (CSF)
• Reaction to the medicine (anesthesia) that puts you in a sleep-like state during surgery
• Temporary headache and nasal congestion

Nonsurgical pituitary tumor treatment

Your health care team may recommend radiation treatment either before surgery to shrink the tumor or after surgery to remove any remaining pieces of the tumor. We have a variety of ways to deliver radiation therapy to precisely target tumors without harming healthy tissues, including intensity-modulated radio therapy (IMRT) and stereotactic radiosurgery.

In the rare case where a pituitary tumor is cancerous, chemotherapy may be recommended either before or after surgery.

After pituitary tumor treatment

Low hormone levels may persist after your treatment. Your doctor will prescribe hormone replacement therapy, which will be needed for the rest of your life.

Follow-up care after pituitary tumor treatment is vital. You’ll need to check in with your doctor regularly to report any new or returning symptoms and to have imaging tests as needed. If you’re taking hormone replacement therapy, you’ll need testing to be sure they’re working for you correctly.