March 2008

Undetected Pituitary Tumors Cause Debilitating Disease

Lewis S. Blevins, M.D.
Medical Director, California Center for Pituitary Disorders
UCSF Medical Center

Radiologic images, MRI studies and autopsy reports show that one in five people worldwide has a pituitary tumor. These benign neoplasms often remain undetected because they present with a vast array of nonspecific symptoms that physicians attribute to depression, anxiety or malingering. Many patients spend years misdiagnosed as their tumors grow. In fact, the condition is clinically diagnosed in only 18 per 100,000 people. Undetected pituitary tumors can cause debilitating and life-threatening cardiovascular disease and adrenal, gonadal and thyroid insufficiency.

Primary care physicians are typically the first health care providers to see patients with pituitary tumors. Opportunities for early diagnosis and treatment require a thorough understanding of the signs and symptoms of anterior pituitary hormone excess, anterior pituitary hormone deficiency and mass-effect symptoms.

The pituitary gland, located in the sella turcica within the sphenoid bone at the base of the skull, secretes various hormones that, in turn, drive the production of hormones made by target glands including the gonads, thyroid and adrenal glands. The pituitary also produces growth hormone and prolactin. Patients with pituitary tumors may have disruption of hormone production leading to partial or complete deficiencies in any one of these hormones.

In most cases, pituitary tumors can be effectively removed through transsphenoidal surgery or advanced radiosurgery using the Gamma Knife, available at select medical centers nationwide including UCSF Medical Center. Experts at UCSF — a major center for the diagnosis and treatment of pituitary disorders — perform radiosurgery with the newest and most advanced Gamma Knife, called the Leksell Perfexion.

Signs and Symptoms

About 40 percent of pituitary tumors are derived from a hormone-producing cell of the gland, resulting in conditions associated with hormone overproduction such as acromegaly, Cushing's syndrome caused by excess ACTH production, hyperthyroidism caused by excess TSH production and galactorrhea and amenorrhea caused by excess prolactin production.

Common symptoms include:

  • Amenorrhea
  • Decreased libido
  • Depression
  • Erectile dysfunction
  • Fatigue
  • Galactorrhea
  • Infertility
  • Mood swings
  • Muscle mass decline
  • Weight gain

Symptoms may resemble those seen in patients with hypothyroidism, adrenal insufficiency and hypogonadism. Patients also may suffer from "mass effects," such as headache, vision loss or double vision, caused by the pressure exerted by the tumor on the adjacent anatomical structures.

Delayed Diagnosis

Pituitary tumor signs and symptoms are typically not considered part of an overall syndrome and therefore diagnosis is delayed. For example, patients with acromegaly often have a delay in diagnosis of seven years from the time that the first manifestations of pituitary tumors, such as carpal tunnel syndrome, dental abnormalities, sleep apnea, hypertension and growth of the hands and feet. An estimated 2 percent to 3 percent of patients diagnosed with uncontrolled diabetes mellitus actually have Cushing's syndrome. Conditions such as hypertension, hyperlipidemia and irregular menses may be caused by metabolic syndrome or Cushing's syndrome due to an ACTH producing pituitary tumor.

Clinical Work-Up

If you suspect that your patient may have a pituitary tumor, a basic initial work-up includes blood tests for:

  • ACTH, cortisol, LH and testosterone for men
  • FSH and estradiol for women with irregular menses
  • Prolactin, IGF-1, growth hormone, TSH and free T4 levels for all patients

A dynamic contrast-enhanced MRI of the pituitary gland, not of the brain, is recommended as the imaging procedure of choice.

For more information, contact the Physician Referral Service at UCSF Medical Center:

Phone (888) 689-UCSF or (888) 689-8273

Other Resources

Primary Care Connections — March 2008