Weill Medical College of Cornell University

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Adult Pituitary Treatment

The pituitary gland sits at the base of the skull and secretes hormones that serve a variety of essential bodily functions. Tumors of the pituitary gland are adenomas, benign, slow-growing tumors made of cells that cover the glands surface. Adenomas may destroy hormone-producing cells or secrete hormones themselves. Other tumors that appear in this area are of different types and may arise from developmental cells; meningiomas, tumors of the protective covering of the brain; craniopharyngiomas, arising from the pituitary stalk; and Rathke Cleft cysts originating from embryonic cells.

Symptoms

Many pituitary tumors remain small and do not cause significant symptoms. Symptoms that arise are caused by two mechanisms: hormonal changes caused by the tumor and the growth of the tumor. Pituitary tumors may damage healthy hormone-producing cells, causing a lack of certain hormones and symptoms including fatigue, weakness, growth problems, and disruption of sexual function. Tumors that produce hormones, known as functioning tumors, often cause symptoms when they are small (less than 1 cm). An excess of hormones can cause a wide range of effects that depend on the hormone, including infertility, abnormal growth, high blood pressure, unusual changes in the skin and body, and specific growth disorders. Larger pituitary tumors (greater than 1 cm) are usually not hormonally active. These nonfunctioning adenomas may cause symptoms by compressing surrounding brain structures, resulting in headaches, nausea, vomiting, and, when they push against the optic chiasm, visual deficits.

Diagnosis

Imaging studies are used to diagnose pituitary tumors, including magnetic resonance imaging (MRI) and computed tomography (CT) scans, enhanced with intravenous administration of a contrast agent distinguishing the tumor from normal tissue.

Treatment

Treatment for a pituitary tumor depends on its hormonal activity and whether it affects surrounding tissue. Both functional and nonfunctional tumors may be treated with surgery sometimes followed by radiation therapy. In addition, drug therapy has shown effectiveness in certain functional adenomas. Surgery to remove pituitary tumors is minimally invasive and performed through the nostrils using endoscopes. This avoids any incisions and the surgery is very well tolerated with little risk. In rare cases, some smaller pituitary tumors may be treated effectively with stereotactic radiosurgery, which involves the use of a highly focused beam of radiation to target the tumor cells.