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Pituitary tumor

Tumor - pituitary; Pituitary adenoma

 

A pituitary tumor is an abnormal growth in the pituitary gland. The pituitary is a small gland at the base of the brain. It regulates the body's balance of many hormones.

Causes

 

Most pituitary tumors are noncancerous ( benign ). Up to 20% of people have pituitary tumors. Many of these tumors do not cause symptoms and are never diagnosed during the person's lifetime.

The pituitary gland is a pea-sized endocrine gland located at the base of the brain. The pituitary helps control the release of hormones from other endocrine glands, such as the thyroid, sex glands (testes or ovaries), and adrenal glands . The pituitary also releases hormones that directly affect body tissues, such as bones and the breast milk glands. The pituitary hormones include:

  • Adrenocorticotropic hormone (ACTH)
  • Growth hormone (GH)
  • Prolactin
  • Thyroid-stimulating hormone (TSH)
  • Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

As a pituitary tumor grows, the normal hormone-releasing cells of the pituitary may be damaged. This results in the pituitary gland not producing enough of its hormones. This condition is called hypopituitarism .

The causes of pituitary tumors are unknown. Some tumors are part of a hereditary disorder called multiple endocrine neoplasia I (MEN I).

The pituitary gland can be affected by brain tumors that develop in the same part of the brain, resulting in similar symptoms.

 

Symptoms

 

Some pituitary tumors produce too much of one or more hormones. As a result, symptoms of 1 or more of the following conditions can occur:

  • Hyperthyroidism (thyroid gland makes too much of its hormones; this is an extremely rare condition of pituitary tumors)
  • Cushing syndrome (body has a higher than normal level of the hormone cortisol)
  • Gigantism (abnormal growth due to higher than normal level of growth hormone during childhood) or acromegaly (higher than normal level of growth hormone in adults)
  • Nipple discharge and irregular or absent menstrual periods in women
  • Decreased sexual function in men

Symptoms caused by pressure from a larger pituitary tumor may include:

  • Changes in vision such as double vision, visual field loss, drooping eyelids or changes in color vision
  • Headache
  • Lack of energy
  • Nasal drainage of clear fluid
  • Nausea and vomiting
  • Problems with the sense of smell
  • In rare cases, these symptoms occur suddenly and can be severe ( pituitary apoplexy ).

 

Exams and Tests

 

Your health care provider will perform a physical examination. The provider will note any problems with double vision and visual field, such as a loss of side (peripheral) vision or the ability to see in certain areas.

The exam will check for signs of too much cortisol (Cushing syndrome) or too much growth hormone (acromegaly).

Tests to check endocrine function may be ordered, including:

  • Cortisol levels: dexamethasone suppression test , urine cortisol test
  • FSH level
  • Insulin growth factor-1 (IGF-1) level
  • LH level
  • Prolactin level
  • Testosterone/estradiol levels
  • Thyroid hormone levels: free T4 test , TSH test

Tests that help confirm the diagnosis include the following:

  • Visual fields
  • MRI of head

 

Treatment

 

Surgery to remove the tumor is often needed, especially if the tumor is pressing on the optic nerves (nerves that control vision).

Most of the time, pituitary tumors can be surgically removed through the nose and sinuses. If the tumor cannot be removed this way, it is removed through the skull.

Radiation therapy may be used to shrink the tumor in people who cannot have surgery. It may also be used if the tumor returns after surgery.

In some cases, medicines are prescribed to shrink certain types of tumors.

 

Support Groups

 

Pituitary Network Association: www.pituitary.org

 

Outlook (Prognosis)

 

If the tumor can be surgically removed, the outlook is fair to good, depending on whether the entire tumor is removed.

 

Possible Complications

 

The most serious complication is blindness. This can occur if the optic nerve is seriously damaged.

The tumor or its removal may cause lifelong hormone imbalances. The affected hormones may need to be replaced, and you may need to take medicine for the rest of your life.

Surgery can sometimes damage the posterior pituitary (back part of the gland). This can lead to diabetes insipidus , a condition with symptoms of frequent urination and extreme thirst.

 

When to Contact a Medical Professional

 

Call your provider if you develop any symptoms of a pituitary tumor.

 

 

Open References

References

Melmed S, Kleinberg D. Pituitary masses and tumors. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 9.

Muh CR, Oyesiku NM. Pituitary tumors. In: Ellenbogen RG, Abdulrauf SI, Sekhar LN, eds. Principles of Neurological Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 40.

 
  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Pituitary tumor

         
         

        Review Date: 10/28/2015

        Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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