Pituitary Tumors

Overview

The pituitary gland is the master hormone control gland.  It regulates numerous hormonal pathways including growth hormone, thyroid hormone, cortisol (the body’s stress hormone), prolactin (involved in milk production), estrogen and testosterone. 

Pituitary tumors can broadly be divided into functional tumors (hormone producing) and non-functional tumors (those that produce no hormone).

Symptoms

Non-functional tumors typically present at larger sizes and frequently cause symptoms related to compression of either the normal pituitary gland or critical adjacent structures such the the optic chiasm (the intersection of the optic nerves).

Functional tumors are typically found at smaller sizes because of their systemic hormone effects, but can also grow to larger sizes. 

Rarely, larger pituitary tumors can suddenly lose their blood supply and/or hemorrhage.  This is known as pituitary apoplexy.  Symptoms can include severe headache, visual loss, double vision, eyelid droop and low blood pressure.  This is an emergency and patients acutely experiencing these symptoms should go to the emergency room.

Treatments

Non-functional tumors that are small and asymptomatic can be followed with imaging.  Larger or symptomatic tumors are typically treated with surgery.

Prolactinoma is the one type of functional tumor that can be treated with medication.  Surgery is first-line treatment for all other functional tumors.

Endoscopic Pituitary Surgery - We have extensive experience in the endoscopic treatment of pituitary tumors.  Traditional techniques use a microscope to gain access to the deep-seated pituitary region, located in the center of the head.  Using the microscope, the corridor is small and illumination relatively poor.  Endoscopy provides far superior illumination, magnification, visualization and access to the pituitary region and the surrounding areas of the skull base.  This results in safer and more effective tumor resection.

In a small percentage of cases, additional treatment with open craniotomy, gamma knife radiosurgery and/or hormonal therapy is also utilized.

Case Studies

Case 1: 61 year old woman with 3 years of progressive fatigue and visual loss.  MRI demonstrated a very large pituitary macroadenoma (Fig 1).  Preoperative endocrine testing indicated that tumor was non-functional.

Tumor was treated in 3 stages:

  • Stage 1: Expanded Endoscopic Endonasal Approach for resection of tumor in sellar, suprasellar, third ventricle regions and tumor compressing brainstem.  Skull base reconstruction with abdominal fat graft and naso-septal flap.
  • Stage 2: Craniotomy for resection of right temporal tumor
  • Stage 3: Gamma Knife to small residual in cavernous sinus

Outcome:  The patient had a very good clinical outcome with marked improvement in her vision. She was able to return to driving. The postoperative MRI demonstrated excellent resection of the tumor (Fig 2).  Small residual in the cavernous sinus remains stable after gamma knife.