Pituitary Tumors and Related Problems

OVERVIEW:

Pituitary adenomas and related tumors that arise around the pituitary gland are relatively common. The most frequently encountered tumors are pituitary adenomas, Rathke’s cleft cysts (RCCs) and craniopharyngiomas. Other tumors that occur in the skull base region near the pituitary gland include meningiomas, chordomas and, sphenoid sinus carcinomas. Other brain tumors that can arise near the pituitary gland include gliomas and epidermoid cysts.

SYMPTOMS:

Given their location, tumors in and around the pituitary gland can cause significant health problems and disability including abnormal pituitary hormonal function, loss of vision, headaches and bleeding.

DIAGNOSIS:

Pituitary tumors and related tumors are best diagnosed by imaging studies, typically magnetic resonance imaging (MRI) or computer tomography (CT) of the brain and pituitary, and pituitary hormonal blood tests.

TREATMENT:

The optimal treatment for pituitary adenomas and related tumors depends on the tumor type and the resulting symptoms. Treatment may involve surgery, medical therapy, radiation and/or hormone replacement therapy. Some tumors which are not causing any symptoms but were discovered by virtue of an MRI may require no treatment and can be followed with repeat imaging and hormonal tests. However, most patients with a symptomatic tumor in this area will warrant surgery or some other form of treatment. Consequently, the care of patients with a pituitary tumor is usually coordinated by a neurosurgeon and an endocrinologist (a specialist in hormonal disorders). Other specialists involved with treating these problems may include an ophthalmologist, oncologist, radiation oncologist, neurologist or head & neck surgeon.

MINIMALLY INVASIVE SURGERY: The preferred surgical route for removing pituitary adenomas, RCCs, chordomas and most craniopharyngiomas is through the endonasal transsphenoidal route (through a nostril without facial or lip incisions). However, a craniotomy may be required to remove some types of these tumors depending upon their growth pattern and location. If a craniotomy is required, in most instances, a minimally invasive supra-orbital “eyebrow” craniotomy can be used to reach such tumors.
MEDICATIONS: Some types of pituitary adenomas (e.g., prolactinomas) can also be treated with medications to shrink the tumor and lower abnormally elevated hormone levels. Hormone replacement therapy (e.g., cortisol, thyroid, estrogen, testosterone) is often needed as well if pituitary function is lost.
RADIOSURGERY & RADIOTHERAPY: Some pituitary adenomas, craniopharyngiomas and other tumors around the pituitary gland that cannot be completely removed surgically are effectively treated with focused radiotherapy using stereotactic radiosurgery (SRS – a single dose of radiation) or stereotactic radiotherapy (SRT - multiple doses).