Pituitary tumours are growths which develop within your pituitary gland. The pituitary gland plays an important role in our body function because it produces hormones (prolactin and growth hormones) as well as regulating hormone production from the thyroid and adrenal glands.

Most pituitary tumours are non-cancerous (known as benign) growths.  A tumour less than 10 mm is called a microadenoma while a macroadenoma is larger than 10mm.  The types of tumours include;

• Non-functional adenomas (most common type) grow slowly and do not cause problems unless they become big enough to compress other structure or the normal pituitary gland cells
• Prolactin hormone producing tumour (Prolactinoma) causes over production of prolactin resulting in milk production or irregular periods (in women) and loss of libido or erectile dysfunction (in men)
• ACTH hormone producing tumour causes over production of adrenocorticotropic hormone (ACTH) which in turn stimulates the adrenal glands to make glucocorticoid (steroid) hormones. These hormones result in Cushing’s disease where you develop weight gain and/or pimples in the face, neck and abdomen as well as reduced immune system and osteoporosis
• Growth hormone producing tumour causes over production of growth hormone which is children causes Gigantism and in adults causes Acromegaly (where there is a sudden increase in feet or hand size, change in your facial features such as jaw or nose and deepening of your voice)

Symptoms

Most non-functional pituitary tumours do NOT cause much symptoms unless they grow big and cause compressive symptoms or hormone deficient symptoms (due to compression on the normal pituitary gland cells).  Functional tumours causes subtle symptoms associated with the hormone over production. 

1. Compression Symptoms

• Headache, nausea or vomiting
• Vision loss (usually loss of peripheral temporal vision)

2. Hormone Deficiency

• Weakness
• Feeling cold
• Irregular periods
• Sexual dysfunction
• Unintended weight loss or gain

3. Hormone Over Production

These symptoms depend of the type of hormone produced (see above)

Click to view UCSF Neurosurgery video on Pituitary Tumour

Diagnosis

You may need the following tests to make a diagnosis;

• Blood and urine tests
• CT / MRI brain scan
• Vision and visual field tests

Treatment Options

Treatment usually involves a group of doctors such as a neurologist, neurosurgeon, endocrinologist and/or ophthalmologist.  Small non-functioning pituitary tumours may not need treatment and only require regular observations by your doctor.  The treatment options depend on the type of tumour, size, your symptoms and your general health.

1. Medication

Medication can be effective in the treatment of some hormone producing tumours by shrinking it so that it does not press on the pituitary gland or other parts of the brain.

• Bromocriptine (Parlodel and Cycloset) and Cabergoline (Dostinex) can treat prolactinomas by decreasing prolactin secretion
• Somatostatin analogs such as Lanreotide (Somatuline) or Octreotide (Sandostatin) can treat growth hormone producing tumours

2. Radiation therapy

Radiation therapy uses high-energy radiation to destroy the tumour cells and may be used in conjunction with surgery or for recurrences after surgery.

• External beam radiation
• Stereotactic radio-surgery
• Intensity Modulated Radiation Therapy (IMRT)

Click to view UPMC video on EEA pituitary surgery

3. Surgery

Surgical is necessary if the tumour is large and causing loss of vision due to compression on the optic nerves or if the tumour is overproducing certain hormones which is affecting your life.  The two surgical options are;

• Endoscopic Endonasal Trans-sphenoidal Approach is when the tumour is removed through your nose without an external incision on your face or head.  There is no visible scar and recovery is quite fast.  However, large tumours which have invaded into the brain or nerves may be difficult to remove using this method
• Trans-cranial Approach is when the tumour is removed through the upper part of your skull via an opening in your head (known as a craniotomy). This method is necessary for large tumours which have extended out and affected other parts of the brain

Post Surgery Care

• You may take analgesia for any headaches or discomfort for the first few days
• It is normal to feel tired for 3-4 weeks after the treatment so pace yourself and avoid contact sports, heavy lifting, strenuous exercises or swimming for the first month
• Your nose will feel congested and there may be some red discharge initially.  Do NOT blow or pick your nose for the first 7 days after the surgery
• Replacement of pituitary hormones may be required after pituitary surgery or radiation treatment because there will be a drop in hormone production from the pituitary gland.  Your doctor will need to monitor your blood tests on a regular basis and advise when and what you need to take
• See your doctor immediately if you develop a fever or liquid leaking from your nose or have severe headache or drowsiness or feeling thirsty or passing a lot of urine

Discuss with your Neurosurgeon the treatment options available for you & your post-surgical care instructions

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