What is a Pituitary Tumor?
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.
Symptoms of a Pituitary Tumor
Not all pituitary tumors cause symptoms. Sometimes they are identified incidentally on an imaging test such as an MRI or CT performed for some other reason. Pituitary tumors that make hormones (functioning) can cause a variety of signs and symptoms depending on the hormone they produce. The signs and symptoms of pituitary tumors that don’t make hormones (nonfunctioning) are related to their growth and the pressure they put on other structures.
Large pituitary tumors — those measuring about 1 centimeter (slightly less than a half-inch) or larger — are known as macroadenomas. Smaller tumors are called microadenomas. Because of the size of macroadenomas, they can put pressure on the normal pituitary gland and nearby structures.These symptoms can vary in their severity. Learn more about your specific pituitary tumor symptoms, and how they can be treated, at our neurosurgeon offices.
Signs of Pressure Caused by the Tumor
Signs and symptoms of pressure from a pituitary tumor may include:
- Headache
- Vision loss, particularly loss of peripheral vision
Signs of Hormone Level Changes
Deficiency
Large tumors could cause hormonal deficiencies. Signs and symptoms include:
- Nausea and vomiting
- Weakness
- Feeling cold
- Less frequent or no menstrual periods
- Sexual dysfunction
- Increased amount of urine
- Unintended weight loss or gain
Overfunctioning
Functioning pituitary tumors cause an overproduction of hormones. Different types of functioning tumors in your pituitary gland cause specific signs and symptoms and sometimes a combination of them.
Adrenocorticotropic hormone-secreting (ACTH) tumors
ACTH tumors produce the hormone adrenocorticotropin, which stimulates your adrenal glands to make the hormone cortisol. Cushing syndrome results from your adrenal glands producing too much cortisol. Possible signs and symptoms of Cushing syndrome include:
- Fat accumulation around your midsection and upper back
- Exaggerated facial roundness
- Thinning of the arms and legs with muscle weakness
- High blood pressure
- High blood sugar
- Acne
- Bone weakening
- Bruising
- Stretch marks
- Anxiety, irritability or depression
Growth hormone-secreting tumors
These tumors produce excess growth hormone, causing:
- Coarsened facial features
- Enlarged hands and feet
- Excess sweating
- High blood sugar
- Heart problems
- Joint pain
- Misaligned teeth
- Increased body hair
Prolactin-secreting tumors
- Irregular menstrual periods
- Lack of menstrual periods
- Milky discharge from the breasts
In men, a prolactin-producing tumor may cause male hypogonadism. Signs and symptoms can include:
- Erectile dysfunction
- Lowered sperm count
- Loss of sex drive
- Breast growth
Thyroid-stimulating hormone-secreting tumors
When a pituitary tumor overproduces thyroid-stimulating hormone, your thyroid gland makes too much of the hormone thyroxine. This rare cause of hyperthyroidism thyroid disease can accelerate your body’s metabolism, causing:
- Weight loss
- Rapid or irregular heartbeat
- Nervousness or irritability
- Frequent bowel movements
- Excessive sweating
Getting a Pituitary Tumor Diagnosis
If your pituitary tumor symptoms have already led you to receive a MRI or other form of imaging, we invite you to send this imaging to us for an expert diagnosis. Use the convenient and secure “upload your imaging” button to the right, and follow the short, simple steps.
Our expert Florida neurosurgeon clinic will automatically receive your files and then contact you to discuss a plan for your best quality of life.
Conditions
Ways to Avoid Pituitary Tumor Surgery
There are a number of alternative treatment options for this condition that do not require surgery, most of which involve radiation.
Radiation therapy
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.
Medications
- 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.
Replacement of Pituitary Hormones
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.
Watchful Waiting
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.
Pituitary Tumor Treatments and Procedures
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.
Schedule an e-consult with Dr. Morrison to discuss your pituiatry tumor treatment options today.
Pituitary Tumor Prognosis
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.
Immediately following surgery, I was standing and walking pain free. I am enjoying my life again and have Dr. Morrison to thank!
