Pituitary Tumor

The pituitary gland has two sections:

• Anterior pituitary, which is the larger, front part of the gland and where most pituitary tumors start. The anterior pituitary makes the “master” hormones that control production of other hormones.
• Posterior pituitary, which is the back part of the gland that is connected to the hypothalamus of the brain. It stores hormones made by the hypothalamus before they are released into the bloodstream.

There are several types of pituitary tumors, including pituitary adenomas, pituitary carcinomas and rare tumors, such as teratomas, germinomas and choriocarcinomas.

Pituitary adenomas

There are two types of pituitary adenomas:

• Microadenomas are smaller than 1 cm in diameter. It’s unusual for them to damage surrounding tissue, but they can still create a hormone imbalance and cause symptoms.
• Macroadenomas are 1 cm or larger in diameter. These tumors can cause symptoms by pressing on nearby tissues or nerves, as well as by creating a hormone imbalance.

Pituitary adenomas are also categorized by the type and amount of hormone they produce:

• Functional adenomas are tumors that produce too much of a hormone. Most pituitary adenomas are functional. There are several types of functional adenomas based on the hormones they make, which can affect symptoms, diagnosis and treatment.
• Non-functional adenomas are tumors that do not overproduce hormones, but they can cause problems because of their size.

Pituitary carcinomas

Pituitary carcinomas, or cancerous pituitary tumors, are rare. Pituitary carcinomas and pituitary adenomas look the same under a microscope, and both can produce hormones. But carcinomas can spread to distant parts of the body. Physicians may not be able to tell if a tumor is cancerous until it spreads.

Other pituitary tumors

Other very rare pituitary tumors include teratomas, germinomas and choriocarcinomas. They do not produce hormones, but can grow into the surrounding areas and cause problems.

The causes of pituitary tumors are not fully known. While genetics can be a factor in some cases, most people who develop pituitary tumors have no family history of the disease.

The only known pituitary tumor risk factors are inherited gene mutations. People who inherit these mutations from their parents have a significantly higher risk of developing pituitary tumors. Inherited genetic syndromes that raise the risk for pituitary tumors include:

• Multiple endocrine neoplasia, type I (MEN1)
• Multiple endocrine neoplasia, type IV (MEN4)
• McCune-Albright syndrome
• Carney complex

If you believe you may have an inherited syndrome that increases your risk, talk with your doctor about genetic testing.

Researchers don’t know how to prevent pituitary tumors. There are no general screening exams or controllable risk factors. But people who have an increased risk of pituitary tumors due to an inherited syndrome may benefit from regular blood tests to measure hormone levels and identify and treat potential problems.

Functional tumors create hormone imbalances that may cause symptoms sooner than non-functional tumors, which don’t make hormones. Non-functional tumors generally don’t cause symptoms until they grow large enough (macroadenomas) to put pressure on nearby areas, such as the brain or nerves.

The most common pituitary tumor symptoms include:

• Eye muscle weakness (eyes don't move in the same direction at the same time)
• Blurred or double vision
• Loss of peripheral (side) vision
• Sudden blindness
• Headaches
• Facial numbness or pain
• Dizziness
• Loss of consciousness

Macroadenomas and pituitary carcinomas that cause damage to healthy areas of the pituitary gland can interfere with the pituitary gland’s ability to produce certain hormones. Depending on the hormones affected, symptoms may include:

• Nausea
• Weakness
• Unexplained weight loss or weight gain
• Increased growth or loss of body hair
• Feeling cold
• Fatigue
• Menstrual changes or loss of menstrual periods in women
• Erectile dysfunction (trouble with erections) in men
• Growth of breast tissue in men
• Decreased interest in sex

Many of these symptoms may be caused by other conditions. But let your doctor know if you’re experiencing anything unusual, so that you can identify and treat potential problems.

If you have pituitary tumor symptoms, your doctor may recommend diagnostic testing. Scripps physicians use several tools to diagnose pituitary tumors.

Blood test

A blood sample is collected and checked for abnormal levels of hormones that can indicate a problem with the pituitary gland.

Urine test

A urine sample is collected and checked for abnormal levels of hormones that can indicate a problem with the pituitary gland.

Eye exam

An eye exam can help identify vision problems that may be caused by a pituitary tumor pressing on the optic nerve. Peripheral or side vision is often the first visual field affected.

Venous blood sample

A blood sample from a vein close to the pituitary gland is checked for high levels of specific substances released by nearby organs and tissues that could signal the presence of cancer.

Magnetic resonance imaging (MRI)

MRI uses a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.

Computed tomography (CT) scan

A CT scan is an imaging test that captures images of the body from different angles. The images are combined to create detailed cross-sectional views of organs, bones and blood vessels.

Staging describes how far cancer may have spread. Oncologists use stages to develop a cancer treatment plan and prognosis.

But since most pituitary tumors are not cancerous, they are not staged. Those pituitary tumors that are cancerous (pituitary carcinomas) are so rare that no staging system has been developed.

Instead, physicians consider the following when developing a pituitary tumor treatment plan:

• Whether it is a microadenoma (smaller than 1 cm across) or macroadenoma (1 cm across or larger)
• Whether it has grown into nearby structures
• Whether it is causing symptoms, such as vision changes or headaches
• Whether it is functional (making excess hormones) or non-functional
• If it releases hormones, and which ones

Learning all you can about your pituitary tumor diagnosis and your options can help you make informed, confident decisions about the next steps to take.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my treatment plan?
• Will I have to miss work/school?
• What are the side effects of treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps cancer team is here to help you find the answers you need to take an active role in your care. In addition, several community resources provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones.

Your Scripps care team includes professionals from every area of oncology, including endocrinologists, neurologists, surgeons, radiation oncologists and nurses who specialize in this care.

In addition, our nurse navigators can help coordinate your care and ensure you have support and guidance throughout your treatment and recovery. Learn more about how Scripps puts you at the center of care.

Nearly all pituitary tumors are non-cancerous adenomas. Scripps physicians determine pituitary adenoma treatment depending on the size and type of the tumor, whether it is cancerous and which hormones it may produce.

Treatment options for pituitary tumors may include one or more of the following:

Pituitary tumor surgery

Scripps physicians may use several surgical procedures to treat pituitary tumors.

• Transsphenoidal surgery is the most common surgery for pituitary adenomas. The surgeon removes the tumor through an incision in the upper lip or lower portion of nose between the nostrils.
• Endoscopic transsphenoidal surgery is performed using an endoscope, a thin instrument with a camera at one end, to view the area through a small incision in the back of the septum inside the nose. This eliminates the need for an incision in the upper lip or between the nostrils.
• Craniotomy is when the surgeon removes the tumor through an opening in the skull.

Drug therapy for pituitary tumor

A number of medications may be used to stop a pituitary tumor from producing an abnormal amount of hormones, or in combination with surgery. The exact medications used depend on which hormones the tumor produces.

Radiation therapy for pituitary tumor

External beam radiation therapy may be part of a pituitary tumor treatment plan if surgery is not an option, after surgery if all of the tumor is not removed or to treat symptoms that are not controlled by medication.

Some pituitary tumor treatment plans may involve clinical trials. Talk to your physician about whether a clinical trial is right for you.

For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your pituitary tumor treatment plan generally includes:

• Family and medical history
• A summary of your diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your pituitary tumor care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need.

Your team may include:

• Endocrinologists
• Neurosurgeons
• Neurologists
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more on our multidisciplinary approach to treatment.