A pituitary tumor is an abnormal growth in the pituitary gland, a small gland in the brain, behind the nose. It makes hormones that affect many other glands and many functions in your body. Most pituitary tumors are not cancerous (benign) and don’t spread throughout the body. But, they can cause the pituitary to make too few, or too many, hormones.

Pituitary tumors that make too many hormones will cause other glands to make more hormones. That will cause symptoms related to each of the specific hormones. Many pituitary tumors will also press against the nearby optic nerves, which may cause vision problems.

Most pituitary tumors don’t cause symptoms, and are often undiagnosed as a result.

Radiation therapy uses high-energy sources of radiation to destroy tumors. It can be used after surgery or alone if surgery isn’t an option. Radiation therapy can be beneficial if a tumor persists or returns after surgery. Types of radiation therapy are:

• Stereotactic radiosurgery. Often delivered as a single high dose, this focuses radiation beams on the tumor without an incision. It delivers radiation beams the size and shape of the tumor into the tumor with the aid of special brain-imaging techniques. Minimal radiation comes in contact with healthy tissue surrounding the tumor, decreasing the risk of damage to normal tissue.
• External beam radiation. This delivers radiation in small increments over time. A series of treatments, usually five times a week over a four- to six-week period, is performed on an outpatient basis. While this therapy is often effective, it may take years to fully control the tumor growth and hormone production. Radiation therapy may also damage remaining normal pituitary cells and normal brain tissue, particularly near the pituitary gland.
• Intensity modulated radiation therapy (IMRT). This type of radiation therapy uses a computer that allows the doctor to shape the beams and surround the tumor from many different angles. The strength of the beams can also be limited, which means surrounding tissues will receive less radiation.
• Proton beam therapy. Another radiation option, this type uses positively charged ions (protons) rather than X-rays. Unlike X-rays, proton beams stop after releasing their energy within their target. The beams can be finely controlled and can be used on tumors with less risk to healthy tissues. This type of therapy requires special equipment and isn’t widely available.

The benefits and complications of these forms of radiation therapy often aren’t immediate. An oncologist will evaluate your condition and discuss the pros and cons of each option with you.

Treatment with medications may help to block excess hormone secretion and sometimes shrink certain types of pituitary tumors:

• Prolactin-secreting tumors (prolactinomas). The drugs cabergoline and bromocriptine (Parlodel, Cycloset) decrease prolactin secretion and often reduce tumor size. Possible side effects include drowsiness, dizziness, nausea, nasal stuffiness, vomiting, diarrhea or constipation, confusion, and depression. Some people develop compulsive behaviors, such as gambling, while taking these medications.
• ACTH-producing tumors (Cushing syndrome). Medications to control excessive production of cortisol at the adrenal gland include ketoconazole, mitotane (Lysodren) and metyrapone (Metopirone). Osilodrostat (Isturisa) also decreases cortisol production. Potential adverse effects include a heart conduction abnormality that can lead to serious heartbeat irregularity. Mifepristone (Korlym, Mifeprex) is approved for people with Cushing syndrome who have type 2 diabetes or glucose intolerance. Mifepristone does not decrease cortisol production, but it blocks the effects of cortisol on your tissues. Side effects may include fatigue, nausea, vomiting, headaches, muscle aches, high blood pressure, low potassium and swelling.

Pasireotide (Signifor) works by decreasing ACTH production from a pituitary tumor. This medication is given as an injection twice daily. It is recommended if pituitary surgery is unsuccessful or cannot be done. Side effects are fairly common, and may include diarrhea, nausea, high blood sugar, headache, abdominal pain and fatigue.

• Growth hormone-secreting tumors. Two types of drugs are available for these types of pituitary tumors and are especially useful if surgery has been unsuccessful in normalizing growth hormone production. One type of drugs known as somatostatin analogs, which includes drugs such as octreotide (Sandostatin, Sandostatin LAR Depot) and lanreotide (Somatuline Depot), causes a decrease in growth hormone production and may shrink the tumor. These are given by injections, usually every four weeks. An oral preparation of octreotide (Mycapssa) is now available and has similar efficacy and side effects as the injectable preparation.

These drugs can cause side effects such as nausea, vomiting, diarrhea, stomach pain, dizziness, headache and pain at the site of injection. Many of these side effects improve or even go away with time. They can also cause gallstones and may worsen diabetes mellitus.

The second type of drugs, pegvisomant (Somavert), blocks the effect of excess growth hormone on the body. This drug, given by daily injections, may cause liver damage in some people.

If a pituitary tumor or surgery to remove it decreases hormone production, you’ll likely need to take replacement hormones to maintain normal hormone levels. Some people who have radiation treatment also need pituitary hormone replacement.

In watchful waiting — also known as observation, expectant therapy or deferred therapy — you might need regular follow-up tests to determine if your tumor grows. This might be an option if your tumor isn’t causing signs or symptoms.

Many people with pituitary tumors function normally without treatment if the tumor isn’t causing other problems. If you’re younger, watchful waiting can be an option as long as you accept the possibility of your tumor changing or growing during the observation period, possibly requiring treatment. You and your doctor can weigh the risk of symptoms developing versus treatment.

Our South Florida neurosurgery clinic has the expertise to determine the best treatment for you based on:

• How old you are
• Your overall health and medical history
• How sick you are
• How well you can handle certain medicines, treatments, or therapies
• How long the condition is expected to last
• Your opinion or preference

Treatment may include:

• Surgery to remove the tumor: Surgery is often a better option for smaller tumors.
• External radiation: This treatment sends high levels of radiation right to the cancer cells. Special shields may be used to protect the tissue around the treatment area. These treatments are painless and usually last a few minutes.
• Radiosurgery: This uses 1 high dose of radiation sent right into the cancerous tissue. It causes less damage to nearby tissues. It is not actually surgery. But like surgery, it is a 1-session treatment that removes the tumor.

Medication. Different types of medicine may be used to control how much growth hormone is made by the tumor.

Survival rates depend on the type of tumor, the person’s age, and other factors. It is important to remember that statistics on survival rates for people with a pituitary gland tumor are an estimate }

For most people, treatment removes or controls the tumor. It may help to know that many pituitary tumor survivors have learned to live with this uncertainty and are living full lives.

For other people, the tumor might never go away completely.