Pituitary Tumors

Pituitary tumors are abnormal growths in the pituitary gland, and although these tumors are almost always non-cancerous and do not spread, they can still cause damage to the body as they grow. They are diagnosed at a rate of about 10,000 new patients per year, nationwide, according to the American Cancer Society. However, the actual number may be much higher, as doctors estimate as many as 1 in 4 people has an asymptomatic pituitary tumor without being aware.

At The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health, we take a team approach to pituitary gland treatment for optimal outcomes. This involves a team of board-certified medical professionals, including endocrinologists, neurologists, neurosurgeons, and others. While most pituitary gland tumors produce no symptoms, those that do should be treated as soon as possible to improve quality of life.

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What Is the Pituitary Gland?

To understand pituitary tumors and why they can be harmful, it helps to learn more about the function of a normal pituitary gland. The pituitary gland is a small, bean-shaped structure located inside the skull below the brain, above the nasal passages and soft palate in the back of the mouth. It is the “master control gland” for the all other glands of the body, or the endocrine system. It produces hormones to regulate important bodily functions, including growth, blood pressure, sexual function, and much more. Its primary function is to release hormones affecting growth.

The pituitary connects optic nerves of the eyes to the brain, which controls vision. The anterior pituitary causes other endocrine glands to release the following hormones: growth hormone, thyroid-stimulating hormone (which regulates metabolism), luteinizing hormone (which controls the menstrual cycle in women and sperm production in men) and prolactin (reproductive/sex hormones), and others. The posterior pituitary releases vasopressin and oxytocin.

What Are Pituitary Tumors?

Tumors are an abnormal growth of cells and can start virtually anywhere in the body. Pituitary tumors are abnormal cells that grow in the pituitary gland tissues, and are almost always benign (non-cancerous). Many pituitary gland tumors produce no symptoms and go undiagnosed and untreated, unless they are found in routine imaging or blood tests.

In all pituitary tumors, vision loss is a potential hazard, from the increased pressure on the optic nerves, as well as permanent hormone deficiency. Most pituitary tumors originate in the front of the gland, known as the anterior pituitary (the smaller back part is called the posterior pituitary).

Types of Pituitary Tumors and Their Symptoms

Most pituitary tumors produce no symptoms and go undiagnosed. Signs and symptoms are often caused by the tumor putting pressure on the pituitary gland and disrupting the function of the endocrine system. Symptoms related to hormone level changes include hormone overproduction or hormonal deficiencies, which can cause a combination of symptoms. Symptoms are also related to whether there is an overproduction of hormones or a hormonal deficiency.

Nonfunctional adenomas (null cell adenomas) are the most common type of pituitary tumor, and they may not have any symptoms unless the tumor is rather large. If the tumor becomes big enough, it can cause headaches and difficulty with vision.

Prolactin-producing tumors (prolactinomas) are also common, and they are benign tumors which make too much of the prolactin hormone. In women, high prolactin levels can cause irregular menses or even stop periods altogether. These tumors can also induce lactation, even if you are not breastfeeding. In men, they can cause erectile dysfunction and low libido. It can also increase breast size, damage sperm quality, and reduce body hair. In time, it can also create headaches and vision problems.

ACTH-producing tumors make too much of the adrenocorticotropic hormone, which stimulates the adrenal gland to make steroids. Too much ACTH can cause Cushing’s disease, which causes fat buildup in the face, neck, back, belly, and chest.

Growth hormone-producing tumors overstimulate the growth hormone, which cause gigantism. This creates heights over 7-feet and continual growth, joint pain, and heavy sweating. It also causes a deepened voice, joint pain, diabetes, and high blood pressure from heart muscle enlargement.

Thyroid-stimulating, hormone-secreting tumors are a rare cause of hyperthyroidism, which indicates an overactive thyroid. Hyperthyroidism accelerates the body’s metabolism, causing rapid weight loss, irregular pulse, nervousness, frequent bowel movements, and excessive sweating.

Diagnosis of Pituitary Tumors

Pituitary tumors often go undiagnosed because their symptoms mimic other conditions, and sometimes they are found only incidentally when performing a body scan to check for another condition. To start, diagnosing a pituitary tumor involves taking a detailed medical history and performing a physical exam. Your physician may also order blood and/or urine tests to check for hormone overproduction or deficiency. Brain imaging, including CT or MRI scans, may help your doctor judge the tumor’s location and size.

Pituitary Tumor Treatment

Many pituitary tumors require no treatment. Tumors requiring treatment include those that produce symptoms such as hormone overproduction or deficiency. Treatment protocol is guided by a multidisciplinary team of physicians such as neurosurgeons, endocrinologists, and a radiation oncologist, who work together to determine the best therapies for any given patient based on their symptoms, size of the tumor, age, and overall health.

Treatments for pituitary tumors include:

  • Monitoring: Watchful waiting, or observation, is a deferred therapy in which you will be routinely checked to see if the tumor grows. This is often the approach used in patients whose tumors are small or cause no symptoms. You and your doctor can weigh the benefits versus risks of aggressive versus conservative therapies.
  • Surgery: Surgical removal is usually necessary if the tumor puts pressure on the optic nerves or if the tumor is causing hormone overproduction. Two different surgical techniques to treat pituitary tumors include the endoscopic transnasal transsphenoidal approach, which enables a neurosurgeon to remove the pituitary tumor through the nose. It is a minimally invasive approach that requires no external incisions, and no other part of the brain is affected. Traditional surgery is more invasive, and is called craniotomy. A portion of the skull is removed to access the tumor. Craniotomy may be recommended if the tumor is large or the removal is more complicated.
  • Radiation therapy: Radiation uses high beams of energy to destroy tumors. It may be used after surgery or on its own if the tumor is inoperable. Radiation therapy is also useful if the tumor cannot be completely removed through surgery, or if medications do not relieve symptoms. The most modern radiation therapy is called stereotactic radiosurgery, which delivers a high dose of laser-focused radiation without incisions. The healthy tissue surrounding the tumor is not affected.
  • Medication: Medication therapy focuses on blocking excess hormone secretion, which may be able to shrink certain types of pituitary tumors, like prolactin-secreting tumors, ACTH-producing tumors, and growth hormone-secreting tumors. Hormone replacement therapy provides tailored treatment depending on which hormones are deficient. For example, patients may be treated for low testosterone, low estrogen, low cortisol, and diabetes.

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