What Is a Pituitary Tumor?
A pituitary tumor is an abnormal growth in your pituitary, which is a small, bean-shaped gland in your head. The majority of these tumors are benign (not cancer) and often called adenomas.
Because the gland helps regulate your body’s hormone levels, a pituitary tumor can affect the amount of hormones in your body. An increase or decrease can impact how you feel and how your body functions.
Pituitary tumors are primarily tumors in adulthood, but they’ve also been found in children. Also, more women than men have pituitary tumors. If certain hormones increase, they can cause symptoms in women and men; though, the symptoms will be different.
Do Pituitary Tumors Spread?
Pituitary tumors rarely spread. Benign pituitary tumors (adenomas) remain in the pituitary gland or nearby. Most are slow-growing, but as they grow they can impact the brain and surrounding nerves.
Is it Cancer?
Cancerous pituitary tumors are extremely rare. If they are found, they are typically in older patients. These tumors are called pituitary carcinomas. When these pituitary carcinomas spread beyond the pituitary gland, doctors can confirm they are pituitary carcinomas.
A major challenge in pituitary tumor diagnosis is that benign and malignant (cancerous) tumors may look similar under a microscope.
Types of Pituitary Tumors
We categorize pituitary tumors or adenomas based on size and the level of hormone production. Some tumors produce hormones while others do not.
- Pituitary microadenoma—Microadenomas are tumors less than one centimeter in length. Despite their small size, they can still produce excessive hormones.
- Pituitary macroadenoma—Macroadenomas are tumors more than one centimeter long. They, too, may cause an overproduction of hormones. Their larger size may cause pressure on the pituitary gland or nearby nerves.
Functional Vs. Nonfunctional
Many pituitary tumors are called “functional” adenomas when they create an excessive amount of a hormone. Those tumors include:
- Lactotroph adenomas — These produce prolactin, a hormone involved in milk production.
- Somatotroph adenomas — These produce growth hormones.
- Corticotroph adenomas — These create the hormone Adrenocorticotropic hormone (ACTH) that leads to the production of steroid hormones.
The tumors that do not overproduce hormones are called “nonfunctional” adenomas.
Pituitary Tumor Symptoms
Signs of pituitary tumors depend on the size of the tumor and its impact on your hormone production. A tumor can cause either too much of a hormone or too little, which can cause problems.
Some tumors, particularly those that are small, cause no noticeable symptoms.
Too Many Hormones (Hormone Overproduction)
Signs of too many hormones depend on the specific hormone, but can include:
- weight loss,
- muscle weakness,
- fat increase at mid-section,
- increased heart rate,
- increased sweating, and
- enlarging of feet and hands.
Too Few Hormones (Hormone Deficiency)
Signs of too few hormones range, but can include:
- increased urine volume,
- exhaustion,
- reduction in menstrual periods,
- unexplained weight gain or loss,
- nausea, and
- feeling cold.
Symptoms in Men Vs. Women
Tumors that cause an increase in the hormone called prolactin affect the sex hormones differently for men and women. Men may experience problems such as:
- erectile dysfunction and/or
- reduced sperm count.
Women may have:
- a reduction in menstrual periods and/or
- a milk-like discharge from the nipples (even if they are not pregnant or lactating).
Signs You Have a Large Tumor
- Headaches — Your pituitary tumor may cause you to experience headaches, particularly in your forehead, when it puts pressure on your nerves on brain.
- Vision problems — Your pituitary tumor may cause symptoms with your eyes, including loss of peripheral (side) vision, when it presses on the optic nerve. You may also experience double vision, blurring, or sudden blindness.
What Causes Pituitary Tumors?
No one knows what causes the growth of tumors in the pituitary gland. People with some inherited (genetic) conditions, such as multiple endocrine neoplasia, type 1 (MEN1), seem to have an increased risk of getting these kinds of tumors.
Your doctor may recommend genetic screening for you or your family members if you have one of these conditions.
How Common Are Pituitary Brain Tumors?
Pituitary tumors are one of the most common types of tumors. Autopsies suggest that nearly 20 percent of the population may have a pituitary tumor that does not cause significant health problems during the person’s lifetime.
Diagnosis
If your doctor thinks you may have a pituitary tumor or adenoma, you will need an overall physical exam along with:
- A vision exam — Some tumors can affect the optic nerve affecting both sides and overall vision.
- Hormone testing — Urine and blood tests can show if you have an increase or decrease of hormones.
- Imaging — Both magnetic resonance imaging (MRI) and computed tomography (CT) scans can be used to view the existence of a pituitary tumor.
Find a Specialist
Pituitary Tumor/Pituitary Adenoma Treatment
Depending on the type and size of your tumor, your doctor may recommend:
- observation,
- medication,
- radiation, or
- surgery.
Your general health and age may play a role in your doctor’s recommendation.
Observation
Some tumors do not require any treatment if they are small and not causing significant problems. Your doctor may want to check your tumor periodically to see if it has grown or changed. This may particularly be an option for patients who are younger.
Radiation
Your doctor may suggest radiation after surgery or when surgery is too risky. Depending on the method, you may need to receive one dose or many over time. Your dose will be adjusted to match the shape and size of your unique tumor.
You may not know the full impact of radiation on your tumor for months or years.
Radiotherapy — This is a multi-step treatment approach over a period of weeks. You will receive more than five doses in the course of treatment.
Stereotactic radiosurgery — This also uses radiation matching the size of your tumor and requires one to five doses. No actual cutting takes place, despite the name.
Pituitary Tumor Surgery
Endoscopic/Transsphenoidal
Your specialist can remove most pituitary tumors after making a small incision to access the tumor. This type of minimally invasive surgery uses a small camera or a microscope to help surgeons see the tumor. The specialist does not have to open your skull.
Your doctor may choose how to approach the tumor based on your particular situation. Both approaches can have equally successful outcomes.
Endoscopic endonasal (or endoscopic transsphenoidal)--The doctor will use an endoscope--a long, thin tube--to view the tumor and will remove it through the nose and sinuses.
Microscopic transsphenoidal--A microscope will be placed in your nose to help doctors view the tumor. A neurosurgeon cuts through the sinus wall to reach the tumor and remove it.
If your doctor uses these approaches, recovery time for pituitary tumor surgery is shorter. You will need to stay in the hospital for only a few days. Surgery is often very successful with little chance of impact to the brain.
Craniotomy
When a pituitary tumor has grown to a larger size or is more complicated, your doctor may need to cut open your skull to take the tumor out in the safest manner. Your specialist will temporarily remove a small piece of your skull and replace it at the end of surgery.
Pituitary Tumor Surgery Side Effects
While it is normal to have congestion and sinus headache after surgery, your doctor will watch for other, more serious complications. Your risk level may increase for meningitis or other infections.
Your hormone levels may fluctuate. You may need medication if you have a decrease in hormones.
Recurrent Pituitary Tumors
We may treat pituitary tumors that recur (return again and again) with radiation. For some tumors, such as prolactinomas, medicine can help return your hormone levels to normal.
Some tumors may shrink in size and other symptoms—such as headaches—may disappear. For women, your period may return to normal.
Next Steps
If you believe you need an evaluation for a pituitary tumor, you can make an appointment with one of our skull base tumor specialists.
No doctor referral is necessary to come visit us, but please check with your insurance first as some insurance companies require referrals.
Get a Consultation
Not located in Utah? You can contact us for a consultation. Once we have scheduled the call, we will set up a phone call to discuss your diagnosis with you. We will also ask you to send us:
- Copy of the CD of your MRI images,
- Copy of your vision test, and
- Any other testing you may have had (endocrinology or other).
Contact the Destination Care Program
The Destination Care Program is an initiative by U of U Health focusing on care for our out-of-state patients. We are here to help you find the services and information you need. Feel free to contact us:
Email: DestinationCare@hsc.utah.edu
Phone: 801-587-6365