Pituitary tumor

Definition

A pituitary tumor is an abnormal growth in the pituitary gland, the part of the brain that regulates the body's balance of hormones.

Alternative Names

Tumor - pituitary

Causes

The pituitary gland is a pea-sized endocrine gland located at the base of the brain. The pituitary regulates and controls the secretion of hormones from other endocrine glands, which in turn regulate many body processes. These hormones include:

• Growth hormone (GH)
• Thyroid-stimulating hormone (TSH)
• Adrenocorticotropic hormone (ACTH)
• Prolactin

About 75% of pituitary tumors secrete hormones. When a tumor produces excessive amounts of one or more hormones, the following conditions may occur:

• Gigantism or acromegaly (excess growth hormone)
• Hypothyroidism (excess thyroid stimulating hormone)
• Cushing syndrome (excess adrenocorticotropic hormone)
• Prolactinoma (excess prolactin)

As the tumor grows, hormone-secreting cells of the pituitary may be damaged, causing hypopituitarism.

The causes of pituitary tumors are unknown, although some are a part of a hereditary disorder called multiple endocrine neoplasia I

There are other types of tumors that can be found in the same area of the head as a pituitary tumor:

• Craniopharyngiomas
• Germinomas
• Cysts
• Metastatic tumors (tumors that have spread from cancer in another part of the body)

About 15% of tumors located within the skull are pituitary tumors. Most pituitary tumors are located in the anterior pituitary lobe and are usually benign (noncancerous).

Pituitary tumors develop in about 20% of people, although many of the tumors do not cause symptoms and the condition is never diagnosed during the person's lifetime.

Symptoms

Symptoms associated with pituitary tumors include:

• Headache
• Visual changes
  • Double vision
  • Drooping eyelids
• Personality changes
  • Decreased sexual interest
  • Irritability
• Seizures
• Nasal drainage
• Skin changes
• Facial changes
  • Moon face, puffy eyes
  • Enlarged jaw and facial bones
• Hair changes
  • Loss of body hair
  • Coarse, thin head hair
  • Thinning of eyebrows
• Weakness
• Lethargy
• Temperature sensitivity
  • Intolerance to cold
  • Intolerance to heat
• Constipation
• Nausea and vomiting
• Low blood pressure
• Problems with the sense of smell
• Changes in weight
  • Weight loss (unintentional)
  • Weight gain (unintentional)

Symptoms only in women:

• Cessation of menses
• Abnormal nipple discharge
• Excessive body hair

Symptoms only in men:

• Breast development
• Impotence

Exams and Tests

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

Tests that help confirm the diagnosis include the following:

• MRI of head
• Cranial CT scan
• Formal visual field testing

Endocrine function tests include:

• Cortisol levels:
  • Urine cortisol test
  • Dexamethasone suppression test - serum cortisol levels measured after giving dexamethasone to suppress hormonal secretion
  • Saliva cortisol test
• Insulin growth factor-1 (IGF-1) levels
• Thyroid hormone levels:
  • TSH test
  • Free T4 test
• Serum prolactin levels
• Testosterone/estradiol levels
• Luteinizing hormone (LH) levels
• Follicle-stimulating hormone (FSH) levels

Treatment

Pituitary tumors are usually not cancerous and therefore won't spread to other areas of the body. However, they can cause serious problems by putting pressure on the brain. Surgical removal is often necessary, particularly if the tumor is pressing on the optic nerves, which could cause blindness.

Most of the time, pituitary tumors can be removed through a transsphenoidal procedure -- the surgeon accesses the tumor through your nose and sinuses. However, some tumors cannot be removed this way and will require transcranial (through the skull) removal.

Radiation therapy may be used to shrink the tumor, either in combination with surgery or for people who cannot undergo surgery. Medications may shrink certain types of tumors:

• Bromocriptine or cabergoline are the first-line therapy for tumors that secrete prolactin. These drugs decrease prolactin levels and shrink the tumor.
• Somatostatin analogs are sometimes used for tumors that secrete growth hormone, particularly when surgery is unlikely to result in a cure.

Support Groups

The Pituitary Network Association -- www.pituitary.org

Outlook (Prognosis)

If the tumor can be surgically removed, the probable outcome is fair to good, depending upon whether the entire tumor was removed.

Possible Complications

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

Permanent hormonal imbalances may be caused by the tumor or its removal. This may require replacement of the affected hormones.

When to Contact a Medical Professional

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

Ezzat S, Asa SL, Couldwell WT, et al. The prevalence of pituitary adenomas. Cancer. 2004 Aug 1;101(3):613-9. Review.