Overview
Pituitary tumors form in the pituitary gland, a pea-sized organ in the center of the brain, just above the back of the nose. The pituitary gland is sometimes called the "master endocrine gland" because it makes hormones that affect the way many parts of the body work. It also controls hormones made by many other glands in the body. Pituitary tumors are divided into three groups:
• Benign pituitary adenomas: Tumors that are not cancer. These tumors grow very slowly and do not spread from the pituitary gland to other parts of the body.
• Invasive pituitary adenomas: Benign tumors that may spread to bones of the skull or the sinus cavity below the pituitary gland.
• Pituitary carcinomas: Tumors that are malignant (cancer). These pituitary tumors spread into other areas of the central nervous system (brain and spinal cord) or outside of the central nervous system. Very few pituitary tumors are malignant.
Source: National Cancer Institute
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Tumor Types
Pituitary tumors may be either non-functioning or functioning.
• Non-functioning pituitary tumors do not make hormones.
• Functioning pituitary tumors make more than the normal amount of one or more hormones. Most pituitary tumors are functioning tumors. The extra hormones made by pituitary tumors may cause certain signs or symptoms of disease.
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Source: National Cancer Institute
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Symptoms
Symptoms can be caused by the growth of the tumor and/or by hormones the tumor makes. Some tumors may not cause symptoms. Conditions other than pituitary tumors can cause the symptoms listed below. Consult a doctor if any of these problems occur.
Signs and symptoms of a non-functioning pituitary tumor
Sometimes, a pituitary tumor may press on or damage parts of the pituitary gland, causing it to stop making one or more hormones. Too little of a certain hormone will affect the work of the gland or organ that the hormone controls. The following symptoms may occur:
• Headache.
• Some loss of vision.
• Loss of body hair.
• In women, less frequent or no menstrual periods or no milk from the breasts.
• In men, loss of facial hair, growth of breast tissue, and impotence.
• In women and men, lower sex drive.
• In children, slowed growth and sexual development.
Most of the tumors that make Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) do not make enough extra hormone to cause symptoms. These tumors are considered to be non-functioning tumors.
Signs and symptoms of a functioning pituitary tumor
When a functioning pituitary tumor makes extra hormones, the symptoms will depend on the type of hormone being made.
Too much prolactin may cause:
• Headache.
• Some loss of vision.
• Less frequent or no menstrual periods or menstrual periods with a very light flow.
• Trouble becoming pregnant or an inability to become pregnant.
• Impotence in men.
• Lower sex drive.
• Flow of breast milk in a woman who is not pregnant or breast-feeding.
Too much ACTH may cause:
• Headache.
• Some loss of vision.
• Weight gain in the face, neck, and trunk of the body, and thin arms and legs.
• A lump of fat on the back of the neck.
• Thin skin that may have purple or pink stretch marks on the chest or abdomen.
• Easy bruising.
• Growth of fine hair on the face, upper back, or arms.
• Bones that break easily.
• Anxiety, irritability, and depression.
Too much growth hormone may cause:
• Headache.
• Some loss of vision.
• In adults, acromegaly (growth of the bones in the face, hands, and feet). In children, the whole body may grow much taller and larger than normal.
• Tingling or numbness in the hands and fingers.
• Snoring or pauses in breathing during sleep.
• Joint pain.
• Sweating more than usual.
• Dysmorphophobia (extreme dislike of or concern about one or more parts of the body).
Too much thyroid-stimulating hormone may cause:
• Irregular heartbeat.
• Shakiness.
• Weight loss.
• Trouble sleeping.
• Frequent bowel movements.
• Sweating.
Other general signs and symptoms of pituitary tumors:
• Nausea and vomiting.
• Confusion.
• Dizziness.
• Seizures.
• Runny or "drippy" nose (cerebrospinal fluid that surrounds the brain and spinal cord leaks into the nose).
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Source: National Cancer Institute
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Treatment
Different types of treatments are available for patients with pituitary tumors. Some treatments are standard (the currently used treatment, often referred to as “standard of care”), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Surgery
Many pituitary tumors can be removed by surgery using one of the following operations:
• Transsphenoidal surgery: A type of surgery in which the instruments are inserted into part of the brain by going through an incision (cut) made under the upper lip or at the bottom of the nose between the nostrils and then through the sphenoid bone (a butterfly-shaped bone at the base of the skull) to reach the pituitary gland. The pituitary gland lies just above the sphenoid bone.
• Endoscopic transsphenoidal surgery: A type of surgery in which an endoscope is inserted through an incision (cut) made at the back of the inside of the nose and then through the sphenoid bone to reach the pituitary gland. An endoscope is a thin, tube-like instrument with a light, a lens for viewing, and a tool for removing tumor tissue.
• Craniotomy: Surgery to remove the tumor through an opening made in the skull.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Stereotactic radiation surgery uses a rigid head frame attached to the skull to aim a single large dose of radiation directly to a tumor, causing less damage to nearby healthy tissue. It is also called stereotaxic radiosurgery, radiosurgery, and radiation surgery. This procedure does not involve surgery.
The way the radiation therapy is given depends on the type of the cancer being treated.
Drug therapy
Drugs may be given to stop a functioning pituitary tumor from making too many hormones.
Chemotherapy
Chemotherapy may be used as palliative treatment for pituitary carcinomas, to relieve symptoms and improve the patient's quality of life. Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type of the cancer being treated.
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Source: National Cancer Institute
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