Pituitary Tumors

Signs and Symptoms

If a pituitary tumor exists, the pituitary gland may make an excessive amount of hormones. Tumors that make hormones are called functioning tumors and those that don't make hormones are called nonfunctioning tumors.

Tumors that secrete hormones tend to be smaller than the pituitary gland when they're diagnosed. In fact, most pituitary tumors are microadenomas that measure 3 to 9 millimeters in diameter. Less common tumors are macroadenomas that are 10 millimeters or larger in diameter.

Tumors that don't secrete hormones, called endocrine-inactive adenomas, tend to be larger and may compress other tissue such as the optic nerves, causing vision loss.

Patients with pituitary tumors may experience one or more of the following symptoms:

• Headache
• Loss of peripheral vision or decreased acuity in one or both eyes
• Double vision
• Nausea with or without vomiting
• Weight loss or gain
• Loss of appetite
• Fatigue or decreased energy
• Joint pain
• Increase in shoe or ring size
• Development of high blood pressure or diabetes mellitus
• Decreased mental function
• Dizziness

One type of pituitary tumor can cause a woman's breasts to produce milk even though she isn't pregnant and can stop her periods. Women may experience irregular or lack of periods and infertility, while men may have erectile dysfunction, loss of body or facial hair, loss of sexual drive and infertility.

Diagnosis

During your visit to the California Center for Pituitary Disorders at UCSF Medical Center, our medical team will ask you about your medical history as well as your immediate family's medical history. If your primary care physician has sent your previous medical records, we will review this information. Be sure to tell your doctors about any medications you are currently using, including over-the-counter medications, vitamins, nutritional supplements or herbal remedies.

We will examine you in an attempt to discover the cause of your medical problem. This evaluation may include the following:

• Blood or Urine Tests -- These simple tests are used to measure the hormone levels in your blood and urine.

• Electrocardiogram (ECG or EKG) -- A simple, painless test that records the electrical activity of the heart through electrodes placed on the skin of the chest.

• X-rays -- High-energy radiation is used to take pictures of the pituitary gland.

• Magnetic resonance imaging (MRI) -- This is a non-invasive procedure that produces two-dimensional views of an internal organ or structure, particularly your brain and spinal cord.

• Computed tomography (CT) -- This is a non-invasive procedure that takes cross-sectional images of the brain or other internal organs to detect any abnormalities that may not show up on an ordinary X-ray.

For patients with possible pituitary tumors, we also will perform a complete endocrinological evaluation.

Treatment

Pituitary tumors often can be removed safely through a neurosurgical procedure called transsphenoidal surgery. The word "transsphenoidal" describes the path the surgeon follows to reach the pituitary gland. The word comes from "trans," meaning "to cross or pass through," and "sphenoid," the name of the cavity, the sphenoid sinus, that is passed through to reach the pituitary gland. The operation now can be performed without any facial incision under the lip or in the nose.

The surgeon begins the approach to the pituitary gland by entering the nose on one side. The surgeon uses a very tiny microsurgical instruments especially designed for this particular operation and a brilliant fiberoptic light to illuminate the internal anatomy. In addition, a microscope magnifies the surgical area 12 times its actual size. The surgeon then guides the instrument into the nasal cavity and an opening is made in the sphenoid bone. Once through the sphenoid sinus, an opening is made in the wall of the sella turcica to expose the pituitary gland.

The tumor can be readily distinguished from the normal pituitary gland tissue and is removed, preserving the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing. No nasal packing is required after the surgery. Typically, patients go home the following day.

Sometimes it is necessary to place a spinal drain, a tiny tube threaded into the space in the lower back that is occupied by spinal fluid, during surgery. This tube allows the surgeon to remove spinal fluid or inject saline solution into the spinal fluid space. Because the spinal fluid in the lower back mixes with the fluid around the brain and pituitary gland, changes in the level of the fluid in the spinal area can move the pituitary gland in such a way that the surgeon can remove the tumor more easily. Some patients wake up after the operation with a mild lower back pain, a small bandage on their back and maybe even a drainage bag that will remain in place for 24 hours.

High-Precision Radiosurgery

The Gamma Knife is an advanced radiosurgery treatment used for small to medium size tumors, such as pituitary adenomas. It can also treat epilepsy, trigeminal neuralgia and abnormal blood vessel formations located deep in the brain. Despite its name, it isn't a knife but delivers a single, very finely focused, high dose of radiation precisely to its target, while causing little or no damage to surrounding tissue. Abnormalities measuring 1.5 inches in diameter or smaller -- even abnormalities no larger than a small pebble -- are treated with the Gamma Knife.

Medical Therapy

The goal of medical therapy is to block the tumor from making abnormal quantities of hormones. Specific drugs are used to control specific types of hormone secretion. The production of prolactin is controlled by use of the drug bromocriptine, which reduces the size of the tumor while maintaining normal prolactin levels. Bromocriptine also may be used with other treatments as well. Somatostatin analogues, such as Sandostatin, are used in conjunction with surgical removal for growth hormone-secreting tumors. These drugs are also used on recurrent tumors. Mitotane (Lysodren) and ketoconazole (Nozoral) are drugs used for ACTH-secreting tumors.