ROCKVILLE, CENTRE, NY – Neurological Surgery, P.C. (NSPC) has published an in-depth newsletter addressing the diagnosis and treatment of tumors of the pituitary gland. The eight-page publication was written by neurosurgeon Michael H. Brisman, M.D., F.A.C.S., who specializes in treating these and other tumors of the brain, as well as in treating trigeminal neuralgia, a type of facial pain. Dr. Brisman has successfully treated hundreds of patients with pituitary tumors.
Dr. Brisman is CEO of Neurological Surgery, P.C.; Chief of the Division of Neurosurgery and Co-Director of the Neuroscience Institute at Winthrop-University Hospital; as well as Co-Medical Director of Long Island Gamma Knife and Chief of Surgical Neuro-Oncology at South Nassau Communities Hospital.
“Pituitary tumors often present with symptoms, such as frontal headaches and visual problems, that are also common in other conditions,” said Dr. Brisman. “This means it is of the utmost importance that each case be carefully assessed. We want to educate the medical community about how to recognize and evaluate these tumors, and to let patients know that effective treatments are often available.”
Tumors of the pituitary gland, which are considered a type of brain tumor due to their location, are almost always benign – a type of tumor know as an “adenoma.” Small adenomas are very common, and have been found incidentally after death in as many as 20-25% of people. Pituitary tumors that cause symptoms are much less common, and represent about 15% of clinically symptomatic primary (non-metastatic) brain tumors.
“Even when benign, pituitary tumors can cause a range of problems, such as the aforementioned symptoms, as well as hormonal changes,” said Dr. Brisman.
The pituitary gland is located in the front of the skull base, and is attached to the brain’s hypothalamus. Because the pituitary is considered a “master” gland, it directs the activity of a number of other glands and organs throughout the body. The hypothalamus acts on the pituitary gland, and the pituitary gland releases hormones that act on distant glands and organs, causing the glands to release hormones. Through these processes, the pituitary regulates various functions including metabolism, growth and fertility.
Some (but not all) pituitary tumors secrete hormones, and these secretions can lead to such conditions as the growth disorders acromegaly and gigantism, as well as Cushing’s disease and reproductive disorders. Testing for pituitary tumors is often done when a patient appears to have hormonal problems or the aforementioned frontal headaches or vision problems.
Surgery is usually the first-line treatment for large adenomas that do not secrete hormones, as well as for those causing acromegaly and Cushing’s disease. Minimally invasive techniques are generally used – utilizing either a surgical microscope or endoscope to guide the procedure – unless the tumor is very large. Radiation is usually the second-line treatment for these tumors, if some of the tumor remains after surgery or the patient is not a good candidate for surgery.
“I usually perform this radiation treatment with stereotactic radiosurgery,” said Dr. Brisman. In stereotactic radiosurgery, a highly focused radiation beam is delivered precisely to the tumor.
Pituitary tumors that secrete hormones are generally treated with medications – either hormone replacement or hormone suppression therapies, depending on the hormonal effects of the patient’s pituitary tumor.
“Many benign pituitary tumors are also not actively treated, but observed over an extended period, to ensure that they do not grow and cause other problems,” said Dr. Brisman.
Treatment of malignant tumors, which are rare, may involve surgery and radiation therapy, and sometimes chemotherapy as well.