Pituitary tumors are quite common. As many as one quarter of the population may have tiny tumors not requiring treatment. Symptom-causing tumors and larger tumors are much less likely. Usually, pituitary tumors are benign pituitary adenomas and can almost always be treated with observation or minimally invasive techniques.
The pituitary gland, or master gland, helps regulate hormones throughout the body. Pituitary tumors can cause hormone levels to be too high or too low. These tumors can also cause vision problems because they can grow upward, compressing the optic nerves. This can result in a syndrome affecting peripheral vision called bitemporal hemianopsia. Less commonly, pituitary tumors can present as a life-threatening syndrome called apoplexy, where they bleed or swell, causing sudden vision problems or hormone level drops.
An MRI with and without contrast or, if necessary, a CT scan, can be used to diagnose a pituitary tumor. Results of endocrine or hormone blood tests also play a role in diagnosis.
Microadenomas are tumors less than 1 cm, while macroadenomas are tumors larger than 1 cm. Nonsecretory adenomas do not produce excess hormones, but they may compress the normal pituitary gland, inhibiting hormone production and causing an elevation in prolactin. Secretory pituitary adenomas produce an excess of hormones.
If excess prolactin is produced, this may cause irregular periods or a milky discharge from the breast. Acromegaly involves an excess production of growth hormone in the body which, in adults, can lead to enlargement of the hands, feet, or even internal organs. In childhood, this can lead to enlargement of the arms or legs, also called gigantism. Cushing’s disease involves an overproduction of cortisol. This leads to a variety of symptoms, including high blood pressure, diabetes, round faces, and easier bruising.
Many tumors require clinical observation. Patients go for regular blood tests, eye exams, and MRIs. If tumors need to be surgically removed, we usually use minimally invasive techniques, entering through the nasal passages. Various radiation options are also available, including super-focused radiation or radiosurgery, relatively focused, conventional fractionated radiation, and external beam radiation. Patients may also take medication to address their varying hormone levels.
Many tumors, especially smaller ones, require observation only. Others may require medication.
Nonsecretory macroadenomas, or tumors larger than 1 cm that do not produce hormones, often require surgery. When considering surgery, age, symptoms, and health are very important. If there is residual tumor after the surgery, we may follow up with stereotactic radiosurgery and supplemental medication for low pituitary function, if needed.
For patients with secretory tumors of any size that result in either acromegaly or Cushing’s disease, I usually prefer to surgically remove them using minimally invasive techniques such as entering through the nasal passages. If some of the tumor remains, we can perform stereotactic radiosurgery, and we prescribe medications to address any remaining hormone problems.
Almost all pituitary tumors are benign. In addition, almost all of our treatment options are minimally invasive with excellent prognoses.