Tumor and Treatment Information

Pituitary Tumors

The pituitary gland is a small bean-shaped gland located at the base of your brain, somewhat behind your nose and between your ears. Despite its size, the gland influences nearly every part of your body. Its hormones help regulate important functions such as growth, blood pressure and reproduction.

Pituitary tumors are abnormal growths in the pituitary gland. Sometimes pituitary tumors can produce excess amounts of hormones. Other times, a tumor can restrict the pituitary gland, causing it to produce lower levels of hormones (hypopituitarism).

Most pituitary tumors are noncancerous (benign), nonspreading growths (adenomas). Adenomas remain confined to the pituitary gland or surrounding tissues and don't spread to other parts of your body.

Treatment for a pituitary tumor may involve surgery to remove the tumor. Medications or radiation therapy to control growth of the tumor may also be an option. Medications also may be necessary to correct excess or deficient hormone production.

Signs and Symptoms

Pituitary tumors that produce hormones are called functioning tumors. Tumors that don't produce hormones are known as nonfunctioning pituitary tumors.

The signs and symptoms of a functioning pituitary tumor result from excessive or insufficient hormone production, or from pressure of the tumor on surrounding tissues. Different types of functioning tumors can develop in your pituitary gland, each causing specific signs and symptoms:

Thyroid-stimulating hormone (TSH)-producing tumors. When a pituitary tumor overproduces TSH, your thyroid gland makes too much of the hormone thyroxine. This is a rare cause of hyperthyroidism or overactive thyroid disease. Hyperthyroidism can accelerate your body's metabolism, causing sudden weight loss, a rapid or irregular heartbeat, and nervousness or irritability.

Pituitary tumors usually don't grow or spread extensively. However, they can adversely affect your health. If a tumor becomes larger than 1 inch in diameter, complications may occur, such as:

Vision loss. A pituitary tumor can put pressure on the optic nerves close to your pituitary gland and cause loss of vision.

Decreased hormone production. A pituitary tumor can press on surrounding pituitary tissue and cause a decrease in pituitary hormone production (hypopituitarism).

Increased hormone production. A pituitary tumor can cause excess production of normal pituitary hormones, resulting in associated signs and symptoms.

Complications

Pituitary tumors usually don't grow or spread extensively. However, they can adversely affect your health. If a tumor becomes larger than 1 inch in diameter, complications may occur, such as:

Vision loss. A pituitary tumor can put pressure on the optic nerves close to your pituitary gland and cause loss of vision.

Decreased hormone production. A pituitary tumor can press on surrounding pituitary tissue and cause a decrease in pituitary hormone production (hypopituitarism).

Increased hormone production. A pituitary tumor can cause excess production of normal pituitary hormones, resulting in associated signs and symptoms.

Treatment for a pituitary tumor depends on the type of tumor, its size, and how far it has grown into your brain. Your age and overall health also are factors. Because pituitary tumors can cause serious problems by putting pressure on your brain, treatment often is necessary. Early detection of pituitary tumors is key to successful treatment.

Treatment often involves a team of medical experts, including:

• A brain surgeon (neurosurgeon)
• An ear, nose and throat surgeon (otorhinolaryngologist)
• A doctor who specializes in disorders of the glands (endocrinologist)
• A doctor who specializes in reading medical images (radiologist)
• A doctor who specializes in radiation therapy (radiation oncologist)
• A doctor who specializes in the nervous system (neurologist)
• Doctors generally use surgery, radiation therapy and medications, either alone or in combination, to treat a pituitary tumor and return hormone production to normal levels.

Surgery

The most common treatment for pituitary tumors is surgery. Surgical removal of a pituitary tumor usually is necessary if the tumor is pressing on the optic nerves, which can cause loss of vision. The effectiveness of surgery depends on the type of tumor, its location, its size, and whether the tumor has spread to nearby tissues. The two main surgical techniques for treating pituitary tumors are:

Transsphenoidal hypophysectomy. With this approach, a doctor usually can reach and remove the tumor through your nose and sinuses without an external incision. No other part of your brain is affected, and there's no visible scar. However, very large tumors may be difficult to remove with this procedure, especially if a tumor has invaded nearby nerves or brain tissue.

Transcranial hypophysectomy. This technique reaches and removes the tumor through the upper part of your skull by way of an incision in your scalp. A doctor can more easily reach large or more complicated tumors with this procedure.

Radiation therapy

Radiation therapy uses high-energy X-rays to destroy tumors. It can be used following surgery or alone as primary treatment if surgery isn't recommended. Radiation therapy can be beneficial if a tumor persists or returns after surgery and causes signs and symptoms that medications don't relieve.

External beam radiation. This form of radiation therapy delivers radiation in small increments over a period of time. A series of treatments, usually five times a week over a four- to six-week period, are performed on an outpatient basis.

Although this therapy often is 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.

Stereotactic radiosurgery

Some of the most intriguing new methods in brain tumor treatment involve this type of radiation. The treatment precisely focuses radiation beams to the tumor. No scalpels are involved. Gamma Knife (stereotactic radiosurgery) delivers radiation beams in the exact size and shape of the tumor with the aid of brain imaging techniques.

The advantage of stereotactic radiosurgery is that the surrounding, healthy tissue receives a minimal amount of radiation compared to the tumor. It may be used along with external-beam radiation, especially when treating tumors that are in the deep or sensitive areas of the brain, where surgical removal is dangerous. It is a one-day outpatient procedure.

Like conventional radiation therapy, the benefit of stereotactic radiation is also not immediate and may take months or years to be fully effective. Although this technique is relatively new, the early results are very encouraging. Unfortunately, this therapy cannot be used for tumors that are very close to important nerves near the pituitary, such as those needed for vision. It still is most often recommended when surgery has not been successful.

This technique has other advantages over traditional surgeries:

• The patient is able to avoid the pain and discomfort of a craniotomy.
• The procedure is performed under local anesthesia and does not require any time in an intensive care unit.
• As an outpatient procedure, there is little or no convalescent time; patients are able to resume their normal activities the day following radiosurgery.
• Radiosurgery can be used for patients with tumors located in parts of the brain that are considered high-risk for scalpel or laser surgery.

This information was taken from http://www.mayoclinic.org/pituitarytumors/.