About the Pituitary Gland
The pituitary gland is often referred to as the control center of the endocrine system (“master gland”). This is because it controls and regulates the functions of several other endocrine glands within the body. Remarkably, this regulating gland located at the base of the brain is no larger than the size of an average pencil eraser. The pituitary gland is connected to the brain via the hypothalamus. Ensuring that the pituitary gland is healthy and functioning properly is important to the body's overall well-being.
How do you know if you have a pituitary problem? Ask yourself the following questions to see if you have pituitary disorder. If you can answer yes to two or more of these questions, you may need to check with an endocrinologist on an appropriate course of action.
Have you experienced change in vision, either loss of side (peripheral) vision or blurred vision? Are you experiencing menstrual irregularities? Are you experiencing sexual dysfunction? Are you experiencing an enlargement of the fingers, face or forehead? Do you bruise easily (without injury)? Do your muscles feel weak?
Are they growing at a normal rate? Are they showing signs of puberty too early? Girls before age 7? Boys before age 8? Are they lacking signs of puberty, including girls over age 13 or boys over age 14? Are they drinking excessive amounts of water (more than 2 quarts per day)?
For Menarchal Girls
If you feel that you may have symptoms which could be caused by a pituitary tumor, you should discuss these symptoms with your physician. A detailed history and physical examination will then be done to determine whether measurement of specific pituitary hormones is necessary, as well as formal visual field testing. If findings are suggestive that a tumor may be present, a pituitary magnetic resonance imaging ( MRI) examination may be ordered.
Do they have a milky discharge from their breasts? Have they missed more than one period? If you feel that you may have symptoms, which could be caused by a pituitary tumor, you should discuss these symptoms with your physician. A detailed history and physical examination will then be done to determine whether measurement of specific pituitary hormones is necessary, as well as formal visual field testing. If findings are suggestive that a tumor may be present, a pituitary magnetic resonance imaging ( MRI) examination may be ordered.
If you have been diagnosed with a pituitary tumor (“adenoma”), please review the following supportive information. Pituitary tumors are not a common cause of medical problems. They represent only about 10% of all tumors in the head. They are not “brain tumors,” since the pituitary is located just below the main portion of the brain. Pituitary tumors may sometimes cause headaches, but this is actually quite rare. They do not cause loss of thinking function, movement or sensation. However, if untreated, pituitary tumors may lead to loss of vision as well as symptoms arising as a consequence of pituitary hormone deficiency or excess. With proper care, many people live with pituitary problems and lead normal, healthy, happy lives. Making your endocrinologist a part of your healthcare team is a vital component in maintaining an optimal lifestyle while living with pituitary abnormalities.
Other Pituitary Conditions
In addition to pituitary adenomas, there are many other (admittedly less common) conditions that can affect the pituitary gland, including other tumors, cysts, and inflammation among others. These can also cause pituitary underactivity or lead to vision loss.
What can I expect?
The next steps will be determined based on how the tumor was found. If the tumor was found as part of a routine MRI examination, then further testing will be necessary, which will be more extensive if the tumor exceeds a certain size or appears to press upon the visual pathway on the MRI. If the tumor was found because of pressure symptoms or loss of pituitary function, detailed hormonal testing as well as visual evaluation is necessary. If the tumor was found because of oversecretion of pituitary hormones, the rest of the pituitary hormones will need to be tested.
Taking Charge: Know your stats
After diagnosis, it often becomes necessary to share vital information about your tumor with appropriate medical personnel. Having this information at your fingertips greatly facilitates the efficiency of your physician. The following is information you should keep updated and accessible.
- What is the size of the tumor?
- Is the tumor currently pressing on any vital structures?
- According to the current blood tests, what hormones are over-secreted (present in excess)?
- What hormones are under-secreted (deficient)?
- What are my current symptoms?
- Have I received any treatments for my pituitary condition? If so, which one(s) and when?
This section discusses treatment options for pituitary conditions.
Questions to ask your doctor at each examination
- How often should I come back for follow-up?
- What symptoms would you like me to report to you in between visits?
- Do I need surgery, continued medication, or radiation therapy?
- Do you expect that the medication that I am currently on will be required indefinitely?
What treatments are available for pituitary tumors?
Treatment is based upon the behavior of the pituitary gland. If it is overproducing a chemical called prolactin, then it will be treated, in most cases, with an oral medication (pill) which can reduce the oversecretion of this hormone and often shrink the tumor (if one is present) as well. If the tumor is secreting growth hormone (causing acromegaly or gigantism), or another hormone called ACTH (causing Cushing’s disease), then the gland will be treated surgically in most cases, aiming at removing the tumor while sparing the normal gland. In some cases, where surgery is ineffective, treatment with radiation therapy is used as additional therapy. Often no therapy is prescribed for small, stable tumors that are not over-secreting any hormones and are not otherwise causing vision problems or loss of hormone function. In the event that surgery becomes necessary, it is extremely important that surgery be performed by an experienced pituitary neurosurgeon, as surgical results are dependent upon the skill and experience of the surgeon. Medications may be prescribed in some patients with tumors producing growth hormone or ACTH, generally as second-line treatments after unsuccessful surgery. In these patients, medications can control hormone excess and, in some cases, shrink tumor size.
Medication may also be required to replace the hormones that are deficient. These medications may include hydrocortisone (“cortisone”) or prednisone to replace inadequate adrenal function, thyroid hormone (levothyroxine) to replace lack of hormone in hypothyroidism and sex hormones to replace missing hormones (estrogen and progesterone for women, testosterone for men). Growth hormone replacement is generally necessary to restore appropriate growth in children. Growth hormone deficiency in adults may be associated with symptoms of fatigue and poor quality of life, as well as abnormal fat accumulation and osteoporosis (thinning of the bones). If growth hormone is missing, then its possible use in adults should be discussed in detail with the endocrinologist.
What can I expect from surgery, medications or radiation therapy?
Generally, pituitary tumors are removed by an operation called a transsphenoidal adenomectomy. General anesthesia is required. The pituitary gland is reached by a surgical incision on the inside of the nose or lip that is not visible after healing. The surgeon then proceeds through the sphenoid sinus cavity to reach the tumor. The surgeon generally uses an endoscope or operating microscope to provide magnification and allow optimal view of the tumor during surgery. A small incision is often made in the skin of the abdomen to remove a small amount of fat tissue, which is used to pack the wound after the pituitary tumor is removed. Complications of pituitary surgery are dependent on surgical expertise and may include loss of normal pituitary function (including water balance control) and—sometimes -- infection, bleeding or leakage of fluid from inside the brain cavity (spinal fluid). After surgery, patients generally require blood tests to monitor sodium and cortisol levels in the blood during the first several weeks after surgery. They also need follow-up testing of pituitary function and MRI examination of the pituitary several weeks to months after surgery. Your endocrinologist should discuss with you the surgical team in your area which is best equipped to handle your care. If you live in an area without such a team, referral to a center with experience in pituitary surgery is advised.
Medications can be effective in controlling hormone excess, decreasing tumor size (in some cases) or in replacing missing hormones. In many cases, lifelong therapy is needed. In all cases, regular monitoring and follow-up is needed under the care of the endocrinologist, who will assure that the medication remains effective and well-tolerated.
Radiation therapy for pituitary tumors may take various forms including stereotactic radiosurgery (gamma knife™, proton beam, linear accelerator or Cyberknife™) or conventional radiation therapy. Radiation therapy is best administered in centers with specialized expertise. Radiation therapy directed to the pituitary may lead to loss of pituitary function over time, necessitating regular monitoring (including hormone testing) and institution of appropriate hormone replacement therapy as needed. Otherwise, radiation therapy used for pituitary tumors is generally safe and usually not associated with serious side effects. Your endocrinologist and radiation oncologist will discuss with you the specific indications, benefits and risks of radiation therapy in your particular situation.