What are Pituitary Tumors?
A pituitary tumor develops when cells grow abnormally in the tissues of the pituitary gland, a pea-sized gland in the center of the brain just above the back of the nose. Pituitary gland hormones control the function of many other glands in the body. Although the majority of pituitary tumors are benign (noncancerous), they can cause health problems from increasing pressure on surrounding nerves as they grow, or when they cause overproduction or underproduction of hormones.
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Pituitary tumors may be nonfunctioning or functioning. Nonfunctioning pituitary tumors do not make extra amounts of hormones. Functioning pituitary tumors make more than the normal amount of one or more hormones. Most pituitary tumors are functioning tumors, producing extra hormones that cause signs and symptoms.
There are three groups of pituitary tumors. Benign (noncancerous) pituitary adenomas grow very slowly and do not spread to other parts of the body. Invasive pituitary adenomas (malignant) may spread to the bone of the skull or the sinus cavities. Pituitary carcinomas are rare malignant tumors that can spread to other areas of the brain or spine.
About the host: UTHealth Neurosciences leader Dr. Arthur L. Day is a neurosurgeon and Vice Chair of the Vivian L. Smith Department of Neurosurgery at UTHealth. View his presentation on advanced treatment options for pituitary tumors.
What You Can Expect at UTHealth Neurosciences
At UTHealth Neurosciences, neurologists, neurosurgeons, interventional pain management specialists, neuro-oncologists, radiation oncologists, and neuropathologists work together to determine the care each patient needs, discussing treatment options as a group. This approach saves our patients time and money and allows our specialists to share each other’s insights, leading to better treatment decision-making and outcomes.
We first investigate options for nonsurgical treatment, including medical management, pain management, physical therapy, rehabilitation, and watchful waiting. When surgery is needed, our neurosurgeons routinely employ innovative minimally invasive techniques. Throughout the treatment process, our team works closely with the doctor who referred you to ensure a smooth transition back to your regular care plan. While you are with us, you can expect expert care, excellent communication, and genuine compassion.
Causes of Pituitary Tumors
There is no known specific cause for pituitary tumors, although research has shown that these types of tumors occur more frequently in people with hereditary disorders such as multiple endocrine neoplasia type 1 syndrome, Carney complex, and isolated familial acromegaly.
Early Signs of Pituitary Tumor
Depending on the type of tumor, symptoms may first appear as hormonal differences, or as nerve compression from tumor growth, or both. They may come on suddenly or appear gradually over time.
Signs and symptoms of a nonfunctioning pituitary tumor may include headache; some loss of vision; loss of body hair; less frequent menstrual periods in women; loss of facial hair, growth of breast tissue, and impotence in men; lower sex drive; and slowed growth and sexual development in children.
When a functioning pituitary tumor makes extra hormones, the signs and symptoms depend on the hormone produced.
Too much prolactin may cause headache, some loss of vision, less frequent or no menstrual periods, trouble becoming pregnant, impotence in men, and lowered sex drive.
Too much ACTH (adrenocorticotropic hormone) may cause headache; some loss of vision; weight gain in the face, neck, and trunk of the body and thin arms and legs; a lump of fat on the back of the neck; easy bruising; growth of fine hair on the face, upper back, or arms; and/or anxiety, irritability, and depression.
Too much growth hormone may cause headache; some loss of vision; in adults, growth of the bones in the face, hands, and feet (acromegaly); in children, the body may grow much taller and larger than normal; tingling or numbness in the hands and fingers; joint pain; excessive sweating; and/or extreme dislike of or concern about one or more parts of the body (dysmorphophobia).
Too much thyroid-stimulating hormone may cause irregular heartbeat, shakiness, weight loss, trouble sleeping, frequent bowel movements, and sweating.
Other general symptoms of pituitary tumor may include nausea and vomiting, confusion, dizziness, seizures, and a runny nose caused when cerebrospinal fluid surrounding the brain and spinal cord leaks into the nose.
To diagnose a pituitary tumor, your neurological team will do a physical exam, eye exam, and neurological exam and complete medical history. You will be asked to have an MRI scan, blood chemistry study, and blood test. You may be asked to collect urine for 24 hours to measure the amount of certain substances in your body; a higher than normal amount of cortisol may be a sign of a pituitary tumor and Cushing syndrome. Your team may also order other more specialized tests to measure the level of cortisol in your body.
Each patient’s treatment options are unique, and vary based upon the tumor size and location, as well as the patient’s age, overall health, and other factors. Some tumors may require watchful waiting, with specialists tracking growth over time.
In general, four treatments are available for pituitary tumor. Many tumors can be removed by either minimally invasive surgery or craniotomy, which is surgery through an opening made in the skull.
For invasive pituitary adenomas and pituitary carcinomas, which are cancerous, more than one treatment will likely be recommended to you, including surgery, radiation therapy, targeted drug therapy, or chemotherapy.
Neurologists, neurosurgeons, neuro-oncologists, radiation oncologists, and neuropathologists discuss cases in depth weekly at a tumor board review. Working as a team ensures that each patient benefits from the full spectrum of expertise and the best treatment options available, including new drug therapies and immunotherapies being tested in clinical trials.
FAQ: Common Questions About Pituitary Tumors
What is a pituitary tumor?
A pituitary tumor is abnormal cell growth on the pea-sized pituitary gland at the base of the skull, about 3.5 inches behind the bridge of the nose. Most pituitary tumors are benign, so they are not cancerous. They can, however, cause health concerns by pressing on nerves or interfering with hormone production. In most cases, they do not cause symptoms and are detected in testing for other conditions.
What is the pituitary gland?
This important gland, sometimes referred to as the “master gland,” is located in the base of the brain and produces hormones that control several bodily functions, including metabolism, growth, sexual maturation, reproduction, and blood pressure. While it is small, the pituitary gland influences nearly every part of your body.
How are pituitary tumors treated?
Because pituitary tumors are benign, we can often just monitor small ones. Some patients have pituitary tumors that grow and press on the nerves that control vision. In those cases, treatment would be recommended. Patients sometimes discover pituitary tumors because vision loss prompts them to visit an eye doctor, who diagnoses the tumor.
For prolactin-secreting pituitary tumors, medication may be the best option, but for most other pituitary tumors, surgery is the best option. Some pituitary tumors may also need to be treated with radiation or radiosurgery, but this is typically reserved for a secondary treatment, as needed.
What does surgery entail?
We often use surgery to remove large pituitary tumors to relieve pressure on optical nerves that might be causing vision loss. In many cases, we can use a minimally invasive technique. It is a relatively low-risk operation that is performed by going through the nose into the sphenoid sinus using a camera. Because there aren’t any actual incisions, pain is less and recovery is faster. Patients who also need radiation are able to start faster. In other cases, neurosurgeons may perform a surgery through a small hole n the skull or through the mouth or the nose.
Will surgery cure me?
This is a tough question and depends on whether your tumor can be resected completely. Even when it is, we still need to follow-up with imaging after surgery to make sure the tumor doesn’t return.
Sometimes the tumor can’t be removed completely and in those cases we may simply watch the residual tumor to ensure it doesn’t continue to grow. In some cases, radiation will be used after surgery to ensure that the chance for growth remains small.
If my tumor is small and doesn’t need surgery, should I still see a surgeon?
It is ideal to have a surgeon monitor your condition. Even when the tumor is benign, it still needs to be followed to make sure it doesn’t cause problems, including vision loss.
Do you do this surgery frequently?
We do this procedure so frequently at UTHealth that we developed a team of doctors that includes ENT and Endocrinology for our patients to receive the best care possible.
At UTHealth Neurosciences, we offer patients access to specialized neurological care at clinics across the greater Houston area. To ask us a question, schedule an appointment, or learn more about the Pituitary Tumor and Vision Change Clinic, please call (713) 486-8000, or click below to send us a message. In the event of an emergency, call 911 or go to the nearest Emergency Room.