A pituitary tumour is an abnormal growth of cells in the pituitary gland, which is the main hormone-producing gland in the body. About the size of a pea, the pituitary gland is located in the center of the brain behind the nose and eyes.
There is no obvious cause of pituitary tumours. Some pituitary tumours might be caused by stimulation from the hypothalamus — a part of the brain that signals the pituitary gland to make hormones.
People who have the rare inherited conditions such as multiple endocrine neoplasia type 1 (MEN-1) — a disorder that causes tumours in the endocrine glands (which secrete hormones into the bloodstream and include the pituitary gland) and the first part of the small intestine — or Carney complex — a disorder that causes several types of tumours, including in the pituitary gland — have a higher risk of pituitary tumours. About 1-5% of pituitary tumours occur within families.
Types of Pituitary Tumours
Almost all pituitary tumours are benign. How serious a pituitary tumour is depends on whether it is:
Signs and symptoms of pituitary tumours:
A pituitary tumour causes symptoms by pushing on brain tissue surrounding the tumour or through excessive or impaired hormone production. Some pituitary tumours may not cause any symptoms.
The most common symptoms include:
Other symptoms include:
Pituitary tumours are not usually diagnosed until symptoms appear.
The treatment for a pituitary tumour will depend on many factors, including:
Because having a pituitary tumour can affect many different organs and systems in the body, doctors from several medical specialties will work together to develop a customized treatment plan for the patient.
Surgery is the most common treatment for pituitary tumours. If the pituitary tumour is benign and in a part of the brain where neurosurgeons can safely completely remove it, surgery might be the only treatment needed. The patient will probably need surgery if the tumour:
The most common types of surgery for pituitary tumours are:
Endoscopic pituitary surgery
Endoscopic pituitary surgery, also called transsphenoidal endoscopic surgery, is the most common surgery used to remove pituitary tumours. The pituitary gland is located at the bottom of your brain and above the inside of your nose. It is responsible for regulating most of your body’s hormones, the chemical messengers that travel through your blood.
Endoscopic pituitary surgery is done with an instrument called an endoscope. An endoscope is a thin, rigid tube that has a microscope, light, and camera built into it, and it’s usually inserted through the nose. The camera lets your surgeon watch on a television screen while inserting other special instruments through the scope to remove the tumour.
Reasons for endoscopic pituitary surgery
Endoscopic pituitary surgery is done to remove certain types of tumours that start to grow in your pituitary gland:
Before endoscopic pituitary surgery
During endoscopic pituitary surgery
The actual surgery may take a few hours. These steps may take place:
After endoscopic surgery
You may need to stay in the hospital for a day or two. During this time, nurses will help you with any dressings and bathroom needs. You will be able to return to a normal diet as long as you are taking fluids well. You will be encouraged to get out of bed and walk as soon as you are able. Aftercare at home may include:
It is important to let your surgeons know about:
For larger or more complicated pituitary tumours, a craniotomy may be needed. In this approach the surgeon operates through an opening in the front and side of the skull. The surgeon has to work carefully beneath and between the lobes of the brain to reach the tumour. Although the craniotomy has a higher chance of brain injury than transsphenoidal surgery for small lesions, it’s actually safer for large and complex lesions because the surgeon is better able to see and reach the tumour and nearby nerves and blood vessels.
For both transsphenoidal surgery and craniotomies, the doctor may use image-guidance with MRI or CT scans before surgery to help plan the best surgical approach. Some centers also use intraoperative MRI, where MRI scans are done in the operating room one or more times during the surgery. As a general rule, smaller pituitary tumours are easier to treat with surgery. The larger and more invasive the tumour, the less likely the tumour can be cured by surgery.
No, in over 99% of patients, this is not a cancer; it is benign. Although the tumour is benign, it can cause problems because of its size, causing loss of vision, loss of normal pituitary function (hypopituitarism) and/or headache or because of excessive hormone production by the tumour.
The risk of many types of cancer can be reduced with certain lifestyle changes (such as staying at a healthy weight or quitting smoking). But pituitary tumours have not been linked with any known outside risk factors. As a result, there is no known way to prevent these tumours at this time. Still, for people at high risk of pituitary tumours due to certain inherited syndromes, there may be ways to find and treat them early, before they cause problems.
Transsphenoidal literally means “through the sphenoid sinus.” It is a surgical procedure performed through the nose and sphenoid sinus to remove pituitary tumours. Transsphenoidal surgery can be performed with a microscope, endoscope, or both. The procedure is often a team effort between neurosurgeons and ENT surgeons.
A traditional microscopic technique uses a skin incision under the lip and removal of a large portion of the nasal septum so that the surgeon can directly see the area. A minimally invasive technique, called endoscopic endonasal surgery, uses a small incision at the back of the nasal cavity and causes little disruption of the nasal tissues. The ENT surgeon works through the nostrils with a tiny camera and light called an endoscope. In both techniques, bony openings are made in the nasal septum, sphenoid sinus, and sella to reach the pituitary. Once the pituitary is exposed, the neurosurgeon removes the tumour.
You may be a candidate for transsphenoidal surgery if you have a:
If you have a prolactinoma or a small (<10mm) non-secretory tumour, surgery may not be required. These types of tumours respond well to medication or may be observed with periodic MRIs to watch for tumour growth.
Some tumours extend beyond the limits of the transsphenoidal approach. For these tumours, a more extensive operation that uses a craniotomy combined with skull base approaches may be needed
No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Specific complications related to pituitary surgery include:
If the tumour is hormone secreting, the endocrinologist will follow your hormone levels after surgery to determine whether you are cured.
Patients with Cushing’s disease usually have small tumours (microadenomas) and are surgically cured about 90% of the time.
Patients with acromegaly often have larger, more invasive tumours. The success rate is about 60% with growth-hormone secreting macroadenomas.
Some pituitary tumours remain surgically incurable due to invasion of the cavernous sinuses and other important structures. Radiosurgery can be used to treat unresectable tumour remnants with very good long-term control rates. If there is residual tumour after surgery for acromegaly, Cushing’s disease, or prolactinomas, medical treatments are available to control the excess hormone secretion.
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