Pituitary adenoma is a benign mass in the glandular tissue of a pituitary. Pituitary adenoma symptoms are of hormonal nature. Pituitary adenoma treatment depends on the individual characteristics of the tumor. Moreover, it is important to note that not pituitary adenomas require treatment. Below you can find more detailed information on this subject.
First of all, let us make it clear what is a pituitary?
This pea- sized gland is also called the “master” gland. It is important to the functioning of the human body. It is found behind the eyes and below the front of the brain. The gland produces hormones that regulate critical body organs and glands, including:
- Thyroid gland
- Adrenal glands
Pituitary tumours form when there are abnormal growths in your pituitary gland. Some pituitary tumours result in overproduction of the hormones that regulate important functions of your body while some pituitary tumours may cause your pituitary gland to under produce hormones.
Most pituitary tumours are non-cancerous growths (adenomas). They stay in the pituitary gland or surrounding tissues and don’t spread to other areas of the body.
There are few methods of pituitary adenoma treatment, which include:
- Removing the tumour
- Controlling growth
- Managing your hormone levels with medications
Depending on the case, your doctor may recommend observation or a ”wait and see” approach.
What are some of the common types of benign pituitary tumours?
- Adrenocorticotropic hormone-secreting (ACTH) tumours: About 16 percent of pituitary tumors secrete too much of ACTH that causes Cushing’s syndrome. Symptoms are:
- High blood pressure
- High blood sugar
- Thinner arms and legs
- Excess fat around the torso
Tumours don’t always cause Cushing’s syndrome. Visit your doctor for tests if you notice any of the symptoms.
- Growth hormone-secreting tumours: Causes your body to produce too much growth hormone. Symptoms can include:
- High blood sugar
- Growth of excess body hair
- Abnormal sweating
- Abnormal growth of your feet and hands
- Prolactin-secreting tumours: Reduces levels of testosterone in men and oestrogen in women. Symptoms may include erectile dysfunction and breast growth in men. In women, it may cause abnormal menstruation and nipple discharge.
- Thyroid-stimulating hormone-secreting tumours: Cause hyperthyroidism and increase metabolism. Symptoms can include:
- Abnormal sweating
- Irregular heart rate
- Abnormal weight loss
- Abnormal bowel movements
PITUITARY ADENOMA SYMPTOMS
Symptoms experienced depend on the size of the tumours and the hormones they release. Common symptoms include:
- Vision loss
Other symptoms specific to certain kinds of pituitary tumours may include:
- Weight gain
- Easy bruising
- Irritability, anxiety, and depression
- Nausea and vomiting
- Flushing of the face
- Weak muscles and bones
- High blood pressure
- Irregular heartbeat
- Large hands and feet (acromegaly)
- Producing breast milk even if not pregnant
- Lack of milk when breast-feeding
- Changes in menstrual cycle
- Lowered sex drive
- Loss of body hair
- Abnormal sexual development in children
PITUITARY ADENOMA TREATMENT OPTIONS
Treatment is not required for many pituitary tumours. For those that require treatments, it depends on the type of tumor, the size and how far it has grown into the brain. Age and overall health are also determining factors.
Surgical pituitary adenoma treatment
If the tumor is pressing on the optic nerves or if the tumor is overproducing certain hormones, then it is necessary to surgically remove the tumour. Success rates depend on the tumour type, location, size and whether the tumor has invaded surrounding tissues. There are 2 main techniques:
- Endoscopic transnasal transsphenoidal approach: Enabled removal of the tumour through the nose and sinuses without external incision. Other parts of the brain are not affected and there will be no visible scar. Tumours that are large may be difficult to remove using this technique. Especially if a tumor has invaded nearby nerves or brain tissue.
- Transcranial approach (craniotomy): The tumour is removed through the upper part of the skull through an incision in the scalp. This method is suitable to remove large or complicate tumours as it’s easier to remove these tumours.
High-energy X-rays are used to destroy tumours. It normally used after surgery or individually when surgery isn’t an option. It is beneficial to the patient if a tumour persists or recurs after surgery and causes signs and symptoms that medications can’t relieve. Radiation therapies include:
- Gamma Knife stereotactic radiosurgery: Normally administered as a single high dose. Radiation beams are targeted on the tumour without any incision. The size and shape of the tumour are visualized with the aid of special brain-imaging techniques. Healthy tissues surrounding the tumour are in minimal contact with radiation. This decreases the risk of damage to normal tissue.
- External beam radiation: Radiation is delivered in small increments over time. Treatment is normally given 5 times a week over a 4 to 6 week period. It is performed on an outpatient basis. It may take many years to fully control the tumour growth and hormone production, however, this therapy is often effective. Remaining normal pituitary cells and normal brain tissue, particularly near the pituitary gland may be damaged.
- Proton beam therapy: Uses positively charged ions (protons) instead of X-rays. Proton beams stop after releasing their energy within their target and can be finely controlled and used on tumours with less risk to healthy tissues. This treatment option requires special equipment and isn’t widely available.
The benefits of radiation therapy often aren’t immediate. It may take months or years to be fully effective. Your condition will be evaluated by a radiation oncologist and the pros and cons of each option will be discussed with you.
Medications for pituitary adenoma treatment
Medications may help to block excess hormone production and may also sometimes shrink certain types of pituitary tumors:
- Prolactin-secreting tumors (prolactinomas): Cabergoline and bromocriptine (Parlodel) are drugs that can decrease prolactin secretion and often help to reduce tumour size. Some of the side effects that may be experienced include drowsiness, dizziness, nausea, vomiting, diarrhea or constipation, confusion, and depression. In some people, compulsive behaviours, such as gambling may develop while taking these medications.
- Growth hormone-secreting tumors: The 2 types of drugs available are especially useful when surgery has been unsuccessful in normalizing growth hormone production. The first type of drug is known as somatostatin analogs (Sandostatin, Somatuline Depot, others) decreases growth hormone production and may shrink the tumour. These are administered by injections, usually every 4 weeks.
Side effects such as nausea, vomiting, diarrhea, stomach pain, dizziness, headache and pain may be experienced at the site of injection. These side effects normally improve or even go away with time. They may also cause gallstones and may worsen diabetes mellitus.
The second type of drug is pegvisomant (Somavert). It helps to block the effect of excess growth hormone in the body. This drug is administered daily by injections. It may cause liver damage in some people.
Replacement of pituitary hormones
When a pituitary tumour or surgery decreases hormone production, replacement hormones will be required to maintain normal hormone levels. Hormone replacement may also be necessary for some people who have had radiation treatment.
Watchful waiting (Observation/Expectant Therapy/Deferred Therapy)
Regular follow-up tests are conducted to determine if the tumour is growing. This could be an option if the tumour isn’t causing signs or symptoms.
Many patients who have pituitary tumours are able to function normally without treatment if the tumour isn’t causing other problems. In younger patients, observation may be an option as long as they are aware that the tumour might grow and treatment may become necessary. This can be further discussed with your doctor so that you can weigh the risk of symptoms developing versus treatment.
DIAGNOSING PITUITARY ADENOMA
Pituitary tumors often go undiagnosed as their symptoms resemble those of other conditions. While some pituitary tumours are discovered due to medical tests for other conditions.
Your doctor will likely take a detailed history and perform a physical exam to diagnose a pituitary tumour. Tests below may also be ordered:
- Blood and urine tests: To determine whether there is an overproduction or deficiency of hormones.
- Brain imaging: CT or MRI scans of the brain to help your doctor determine the location and size of a tumour.
- Vision testing: To determine if the tumour has impaired your sight or peripheral vision.
Your doctor might also refer you to an endocrinologist for extensive testing:
- Hormone Testing: Blood and bodily fluids such as urine and saliva are tested for abnormal hormone levels. Hormone levels will also be tested in response to certain hormone-suppressant medications.