Pituitary Tumors

Introduction to Pituitary Gland Tumors

Often referred to as the “master gland,” the pituitary is essential for controlling processes like growth, metabolism, and reproduction. This tiny but mighty organ, which is located at the base of the brain, regulates the release of hormones that impact almost every bodily area. But the pituitary gland can also develop anomalies, such as a pituitary tumors, just like any other part of the body.

Despite being very uncommon, pituitary tumors can significantly affect general health because they can change the hormone production that controls vital body processes.Pituitary gland functions are crucial to maintain hormonal health. Even though these tumors are usually benign (not cancerous), they can nevertheless cause a number of difficulties, such as hormonal imbalances, visual problems, and even neurological disorders. Some pituitary tumors are discovered by accident and are asymptomatic, but others might produce symptoms that interfere with day-to-day functioning.

Early diagnosis and intervention are crucial for preventing serious complications and effectively managing symptoms. Although the majority of pituitary tumors are curable, their effects on your body’s hormone systems may necessitate continued monitoring and treatment. Early symptom detection can result in faster, more efficient treatment, enhancing quality of life and general health outcomes.

It’s critical to comprehend pituitary tumors, whether you’re here to learn more about them for yourself or a loved one. This page seeks to offer a thorough overview, covering everything from symptoms and diagnosis to management and available treatments. Since early intervention frequently results in better outcomes, we strive to arm you with the knowledge you need to make educated decisions about your treatment. Learn more about how to deal with a pituitary tumor, how these tumors are identified, and what to anticipate throughout treatment.

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Causes and Risk Factors

The exact cause of pituitary tumors is not well understood, but several factors may contribute to their development. These tumors are believed to arise from genetic mutations or abnormalities in the cellular development regulatory systems. Pituitary tumors are more likely to occur in people with certain rare genetic disorders, such as

• Multiple endocrine neoplasia type 1 (MEN1)
• Carney complex
• Isolated familial acromegaly
• X-LAG syndrome
• Succinate dehydrogenase-related familial pituitary adenoma
• Neurofibromatosis type 1
• Von Hippel–Lindau syndrome

Changes may also influence tumor growth in the body’s endocrine system, leading to hormonal imbalances. A family history of pituitary tumors or specific hereditary conditions may also increase the risk. Additional risk factors include gender, with some studies indicating a slightly higher occurrence in women and age since pituitary tumors are most frequently detected in people between the ages of 30 and 50. Although there is little evidence linking lifestyle or environmental variables to the development of pituitary tumors.

Types of Pituitary Tumors

Pituitary tumors are classified based on size and hormone production.

Types Based on Size:

1. Microadenoma: tumors less than 1 cm in size fall into this category. They can either be functioning or non-functioning.
2. Macroadenoma: tumors measuring 1 cm or more fall under this category. They can be functioning or non-functioning.

Types Based on the Hormones the Pituitary Gland Produce:

1. Functioning adenoma: Pituitary adenomas that produce hormones fall under this category. They are further sub-categorised depending on the type of hormone they make.
2. Non-functioning adenoma: Pituitary adenomas that does not make hormones comes under this category.

Also, the tumors can be termed as pituitary adenomas and pituitary carcinoma based on the metastasis. Pituitary Adenoma is a benign (non-cancerous) tumor confined to the pituitary gland or its immediate surroundings, causing issues through pressure or hormone imbalances whereas Pituitary Carcinoma is an extremely rare malignant (cancerous) tumor that has spread (metastasised) from the pituitary to other parts of the nervous system or body.

Signs and Symptoms

Not all types of pituitary tumors cause significant symptoms, especially microadenoma and non-functional adenomas. Read on to know about the signs and symptoms associated with different types of pituitary tumors.

Symptoms Caused by Macroadenomas

When the tumor grows large enough that it presses on or grows into nearby parts of the pituitary gland, the pituitary tumor symptoms are as follows:

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• Trouble with eye movement, which can lead to blurred or double vision
• Visual field defects (especially loss of peripheral vision)
• Progressive blindness
• Headaches
• Facial numbness or pain
• Dizziness
• Loss of consciousness (passing out)

Sometimes, tumors grow large enough that it presses or destroys the normal parts of the pituitary gland which ultimately lowers the release of one or more pituitary hormones. Depending on which hormones are affected, pituitary tumor symptoms might include:

• Feeling tired or weak
• Unexplained weight loss or weight gain
• Low blood pressure
• Loss of body hair
• Feeling cold
• Menstrual changes or loss of menstrual periods in women
• Erectile dysfunction (trouble with erections) in men
• Growth of breast tissue in men
• Decreased interest in sex

Sometimes, when large tumors press on the posterior part of the pituitary gland, there is a shortage of the vasopressin hormone which can lead to Diabetes insipidus.

Note: Sometimes, tumors cause multiple symptoms simultaneously if there is bleeding or blockage in a blood vessel. It reduces the blood supply to the pituitary gland, causing a rare condition known as Pituitary Apoplexy.

Symptoms Caused by Functional Adenomas

These signs and symptoms majorly depend on which hormone the tumor is making. The following table mentions the pituitary adenoma symptoms caused due to which particular hormone producing tumor:

Symptoms of Non-functional Pituitary Adenoma

There are no significant signs and symptoms associated with a non-functional pituitary tumor. However, once the tumor enlarges, it begins to compress the optic chiasm. Symptoms that may arise include:

• Headaches
• Abnormal low-level hormones
• Peripheral vision-related issues

Gonadotropin-secreting adenomas (gonadotroph adenomas) are generally non-functional adenomas or tumors that don’t make enough hormones. Their symptoms include:

• Headaches
• Vision problems
• Lower levels of sex hormones
• Irregular menstrual periods (in women)
• Erectile dysfunction (in men)

Pituitary Tumor Diagnosis

The following are the diagnostic methods to detect pituitary tumors:

Blood and urine tests: These tests are performed to detect any hormonal abnormalities associated with pituitary tumors.

CT scans: These scans are performed in emergency situations, for preoperative planning, and to evaluate calcification.

MRI (pituitary gland): This imaging test of the head is used to determine the presence of a tumor, its size and location. It also helps in determining whether the tumor is growing into nearby tissues or not. Radiologists may inject a contrast agent into a vein in the arm to enhance the images.

Visual field exam: A pituitary tumor can pressure the optic chiasm, causing vision field defects or peripheral vision loss, a classic sign of optic nerve compression. A neuro-ophthalmologist conducts this test to check the full scope of vision in all directions.

Biopsy: Although rare, a biopsy might be performed if the diagnosis is uncertain or to understand the nature of tumor (benign or malignant). This would involve taking a small sample of tissue from the tumor.

Neurological exam: This is conducted to check for any abnormal reflexes, coordination problems or sensory changes.

Dexamethasone suppression test: This test helps diagnose Cushing’s disease by assessing cortisol suppression. After administering dexamethasone, cortisol levels should decrease in healthy individuals but remain high in those with a pituitary tumor (Cushing’s disease).

Venous sampling for pituitary tumors: Also known as sampling or inferior petrosal sinus sampling (IPSS), this procedure is used to diagnose pituitary tumors, particularly in cases of Cushing’s disease. It involves collecting blood samples from veins near the pituitary gland to measure hormone levels, such as ACTH. This procedure helps differentiate pituitary tumors from other causes of hormone overproduction and guides treatment decisions.

Dynamic Testing: If a pituitary tumor is suspected but not clearly evident in blood tests, dynamic testing may be used. This involves stimulating or suppressing the pituitary gland with medications to assess its function, such as the TRH test for thyroid function and the GH suppression test for acromegaly.

Laboratory tests, such as Immunohistochemistry (IHC), and Immunocytochemistry (ICC): For pituitary tumors, IHC and ICC help identify specific hormones or markers in tumor cells, aiding in tumor type classification, such as prolactinomas or somatotroph adenomas.

Light and electron microscopy: Light microscopy provides an overview of tumor structure, while electron microscopy offers detailed cellular insights, helping to distinguish between different tumor types and guiding treatment decisions.

Click here to know the about the pituitary tumor diagnostic tests cost and treatment costs in detail.

Hormonal Conditions Associated with Pituitary Adenoma

The following conditions may arise due to the excess or no production of hormones from the pituitary tumors:

Pituitary Tumor Management and Treatment

Pituitary tumor treatment options basically aim to remove or control the growth of the tumor. Treatment procedures includes:

Surgery: It is one of the most preferred treatment options for pituitary adenomas. tumor size, location, and type determine the type of surgery required. The following are the types of pituitary tumor surgery:

• Transsphenoidal Surgery: Pituitary tumors, particularly adenomas, are most commonly treated with transsphenoidal surgery. During surgery, the tumor is accessed by the upper lip or nose, and the sphenoid bone is used to reach the pituitary gland. If this surgery is also performed via endoscope, it is termed as endoscopic transsphenoidal surgery.
• Craniotomy: In this procedure, the skull is opened to remove a larger or inoperable tumor. Comparatively speaking, transsphenoidal surgery is more common.

Chemotherapy: It is primarily performed to treat aggressive or malignant pituitary tumors, like pituitary carcinomas, mainly when surgery or radiation therapy is insufficient to control the cancer. Temozolomide, an oral alkylating drug that has shown efficacy against pituitary tumors, is the most often used chemotherapeutic medication for these instances. Chemotherapy for pituitary tumors can be regional, in which medications are applied directly to particular locations, such as a bodily cavity or cerebrospinal fluid, or systemic, in which drugs are administered through the bloodstream to target the entire body. It aims to control tumor growth and prevent its spread.

Radiation Therapy: It involves reducing or removing malignancies using high-energy radiation, in situations where surgery is not an option or if a tumor persists after surgery. It lessens hormone overproduction, controls tumor growth, and eases symptoms. Side effects include headaches, exhaustion, and even hormone abnormalities. Treatment is often administered over several sessions and frequent follow-ups are necessary to monitor adverse effects and assess efficacy.

Hormone Replacement Therapy (HRT): In order to restore hormone levels that may have been disturbed by the tumor’s impact on the pituitary gland, hormone replacement therapy, or HRT, is utilised. The pituitary gland produces numerous hormones that control essential bodily processes, and a tumor may either overproduce or underproduce these hormones. HRT can assist in reestablishing equilibrium if the tumor results in hormone shortages. Growth hormones, cortisol, estrogen, testosterone, and thyroid hormones are frequently used hormones. The treatment aids in the management of symptoms such as infertility, weight gain, and exhaustion. It is customised for each person according to their unique hormone deficits. To maintain optimal hormone levels, proper dosages and ongoing monitoring is essential.

Medication: In the case of pituitary tumors, it is often used to manage hormone imbalances caused by the cancer or to shrink specific types of tumors. For prolactin-producing tumors (prolactinomas), dopamine agonists such as cabergoline and bromocriptine are frequently recommended because they can lower prolactin levels and cause the tumor to shrink. Octreotide and lanreotide are somatostatin analogs used to treat growth hormone-secreting tumors, such as acromegaly, by reducing growth hormone levels and, in some cases, shrinking the tumor. If the tumor interferes with the synthesis of cortisol, the doctor may give steroids like hydrocortisone. Hypothyroidism brought on by a decrease in thyroid-stimulating hormone (TSH) can be treated with thyroid hormone replacement therapy, such as levothyroxine. Additionally, patients with sex hormone deficits may require supplementation of estrogen, progesterone, or testosterone. Although these treatments aid in symptom management and hormone imbalance correction, if the tumor does not improve with medication, surgery or radiation therapy may still be necessary in certain situations.

Click here to read about pituitary tumor treatment options in detail.

Treatment Success Rate

The success of pituitary tumor treatment depends heavily on several factors, such as tumor type (adenoma vs. carcinoma), size (microadenoma <1 cm vs. macroadenoma ≥1 cm), hormone production (functioning vs. non-functioning), invasiveness into surrounding structures, and the patient’s overall health.

Success rate of Pituitary Adenomas (Benign Tumors)

Firstly, considering the success rate of surgical treatment, transsphenoidal surgery is standard for most adenomas (not typically prolactinomas), achieving high cure rates (>80-90%) for non-invasive microadenomas. Success is lower for macroadenomas, especially if invasive (remission often <60%). Therefore, surgery might aim for partial removal to alleviate pressure, followed by other therapies like medication or radiation. Despite lower cure rates in complex cases, surgical intervention frequently leads to significant improvement.

Note: When referring to surgery, remission means that after the surgical procedure, the disease is no longer detectable or the signs and symptoms have significantly improved. 

Secondly, drugs work quite well, especially for prolactin-producing tumors (prolactinomas). About 80–90% of patients had their tumors shrunk, and their prolactin levels returned to normal by taking dopamine agonists, which can occasionally avoid surgery. Also, these medications are frequently used in conjunction with or following surgery.

Thirdly, radiation therapy is a very good way to inhibit the growth of tumors (tumor control rates are generally >90-95%). This treatment is often used in conjunction with medications. It may or may not help the hormone levels to return to normal. Also, up to 30–60% of patients may develop hypopituitarism (loss of normal pituitary function) within 10 years after radiation therapy, making it a serious long-term concern.

Success Rate of Pituitary Carcinomas (Malignant Tumors)

These are extremely rare and treatment is challenging in these cases. The focus is often on controlling the tumor’s growth, managing symptoms, and preventing spread (metastasis), rather than a complete cure. Success rates are significantly lower than for adenomas due to the aggressive nature of the cancer.

Overall, for the vast majority of pituitary tumors (adenomas), treatment success rates are very good, aiming for tumor removal/control and hormone balance. For rare carcinomas, treatment seeks to manage the disease and maintain quality of life.

Complications Related to Pituitary Tumor Treatment

Pituitary tumor treatment basically aims to remove or control the growth of the tumor. It also normalises hormone levels and preserves the normal function of the pituitary gland while protecting nearby structures, such as the optic nerve. Although the treatment options are considered safe, some potential complications can arise in certain patients.

Cerebrospinal fluid leakage, meningitis, diabetes insipidus, pituitary hormone deficiencies (Hypopituitarism), vision problems and damage to the carotid artery are Some of the significant complications associated with surgical treatment, mainly transsphenoidal surgery.

Other potential surgical complications include bleeding/hemorrhage, cranial nerve damage, nasal and sinus issues, Syndrome of Inappropriate ADH Secretion (SIADH), stroke/brain injury, seizures, reactions to anesthesia, blood clots (DVT/PE), and infection at the surgical site.

Radiation therapy complications include hypopituitarism, vision problems, cognitive changes, secondary tumors, and radiation necrosis. Complications related to radiation therapy have often delayed onset, i.e., they usually appear months to years later.

In cases where there is an untreated, partially treated, or residual tumor, there is a high likelihood of persistent hormonal imbalances. Failure to identify and adequately replace hormone deficiencies (whether pre-existing from tumor pressure or caused by treatment) can lead to significant health issues, including fatigue, weakness, weight changes, inability to handle stress, infertility, and potentially life-threatening adrenal crisis (if cortisol deficiency is missed).

Even after seemingly successful initial treatment (surgery or radiation), some pituitary tumors have the potential to grow back over time. Hence, tumor recurrence is another major complication to be considered and requires long-term monitoring.

Patients must have a detailed discussion with their doctors to understand the specific risks and benefits relevant to their situation before proceeding with any treatment.

Prognosis and Survival Rate

Prognosis refers to the likely course and outcome of the disease.

In case of pituitary adenomas (benign), the prognosis for pituitary adenomas is generally excellent. Most patients achieve long-term tumor control or cure with appropriate treatment. The survival rate is typically comparable to the general population. However, uncontrolled hormone excess or hormone deficiencies can lead to significant morbidity (illness) and increased mortality if not properly managed. Complications from very large tumors can also impact quality of life. Effective treatment and management of hormonal imbalances are key to a normal lifespan.

In case of pituitary carcinomas (malignant), the prognosis is unfortunately poorer than for adenomas due to their aggressive behavior and potential for metastasis (spread). The survival statistics vary due to the rarity of the condition. Some studies report a median survival of around 2-4 years after diagnosis of metastasis, but outcomes are highly variable whereas some stats often mention a 5-year survival rate. Advances in treatment, including targeted therapies, are continuously being explored to improve outcomes.

Follow-Up Care

Pituitary tumors have a 16% recurrence rate over 10 years after the initial surgery/treatment. Long-term follow-up care is essential for anyone diagnosed with a pituitary tumor, regardless of whether it was an adenoma or carcinoma and irrespective of the treatment received.

Key components of follow-up care typically include:

• Regular endocrinologist visits for primary hormone management
• Neurosurgeon check-ups post-surgery
• Ophthalmologist visits for vision monitoring
• Radiation Oncologist follow-up if radiation was used to monitor consequences
• Frequent blood and urine tests for hormone assessment
• Check for recurrence markers via hormone levels if applicable
• Screen for hypopituitarism
• Manage hormone replacement to adjust doses if needed
• Consistent medication use for hormone replacements
• Periodic pituitary MRI scans to check for tumor changes
• Monitor residual tumor, if any remains post-surgery
• Watch for tumor regrowth as early detection is key
• Assess radiation effects to cope up with long-term impact on imaging
• Routine visual field tests especially if vision was at risk
• Monitoring bone density
• Cardiovascular risk assessment
• Fertility evaluation/counseling if relevant
• Address physical and emotional health
• Address overall well-being

Living with a Pituitary Tumor

Living with a pituitary tumor demands regular monitoring and care, and it is essential to have a proactive approach to lifelong health. Since pituitary tumors disrupt hormone balance and can lead to symptoms such as headaches, fatigue, mood swings and vision problems, it can be challenging to live with one. Medications, surgery, radiation treatment, and frequent medical checkups are needed to monitor hormone levels and tumor growth. Day-to-day living may be managed through a healthy lifestyle of regular exercise, a balanced diet, and proper rest to avoid stress and fatigue. The daily activities or work may have to be altered due to hormonal imbalances and eyesight problems. Emotional health is equally vital and can be helped with therapy, friends’ support, or family since chronic disorders can accompany despair and anxiety. Being able to make healthier decisions and improve the quality of life effectively is essential. Most individuals can successfully manage their symptoms if they receive proper care and treatment. Although pituitary tumors involve ongoing issues, being proactive improves long-term health results.

FAQs

Q1. Can a pituitary tumor be cured?

Yes, many pituitary tumors can be treated and cured, often through surgery or medication, especially microadenomas. But the complete cure depends on tumor type, size, invasiveness, and response to treatment.

Q2. How long can a person live with a pituitary tumor?

Most people with pituitary tumors live a normal lifespan, particularly if the tumor is benign and managed appropriately. Although research shows that the 5-year survival rate of pituitary adenomas is over 97%, meaning that the vast majority of people go on to live at least 5 or more years following diagnosis.

Q3. How much does pituitary surgery cost?

The pituitary tumor surgery costs around Rs. 2,00,000 to Rs. 4,00,000. However, costs vary significantly based on location, insurance coverage, hospital fees, and procedure complexity.

Q4. What is the best diagnostic test for pituitary tumor?

An MRI scan is considered the best imaging test to visualize the pituitary gland and detect a tumor. Also, blood and urine tests are essential to measure hormone levels and assess pituitary function.

Q5. Are there non-surgical treatment options available for pituitary tumors?

Yes, there are non-surgical treatment options available for pituitary tumors. Medications are very effective for certain hormone-producing tumors like prolactinomas and can help manage others. Radiation therapy (including stereotactic radiosurgery) is another option, often used if surgery isn’t fully effective or feasible.