Pituitary Tumors

Overview

What are pituitary tumors?

A pituitary tumor is an abnormal, uncontrolled cell growth in your pituitary gland. The cause is often unknown. Pituitary tumors can cause the pituitary gland to produce either too much hormone, or too little. This change in hormone levels can cause a wide range of symptoms.

The pituitary gland is a small gland at the base of your brain, behind your nose. It influences almost every function of your body by controlling the release of most of the body’s hormones, which it also produces.These hormones regulate growth, blood pressure, reproduction and many other bodily functions.  

Are pituitary tumors cancer?

No, most of them are not cancerous (benign), and do not spread to other parts of your body. They tend to grow very slowly. 

How common are pituitary tumors and who gets them?

They are the fourth most common brain tumor, and the most common disease affecting the pituitary gland. They are most common in people in their 30s or 40s, but can occur in children.

Causes

What causes pituitary tumors?

The cause is generally unknown. However, a small number of cases of pituitary tumors run in families, suggesting that genetic changes can influence how these tumors develop.

Symptoms

What symptoms do pituitary tumors cause?

Sometimes there are no symptoms. If you have symptoms, they are generally caused by too much or too little production of one or more hormones or due to compression of the mass on surrounding structures. Symptoms vary widely and depend on which hormone is over- or under-producing. 

Let’s look at the symptoms that each hormone can cause: 

What are growth hormone’s symptoms?

Symptoms depend on your age. In children, increased growth hormone can cause gigantism, causing an extra-large body and height. A low level of growth hormone can cause children to have delayed growth, weak bones and muscles, irritability, and a generally sick feeling 

In adults, growth hormone excess can cause:

  • Acromegaly, which causes a thickened skull or jaw; or enlarged arms, legs, hands and feet
  • High blood sugar (glucose)
  • High blood pressure
  • Heart disease
  • Sleep apnea
  • Headaches
  • Excessive sweating
  • Coarsened facial features
  • Increased body hair
  • Misaligned teeth
  • Joint pain

What are thyroid hormone’s symptoms?

Changes in the thyroid stimulating hormone (TSH) resulting in excess or insufficient production of active thyroid hormone can cause:

  • Nervousness or irritability
  • Rapid heart rate
  • Increased sweating
  • Weight loss with high TSH
  • Weight gain with low TSH
  • Fatigue
  • Sensitivity to hot or cold temperatures
  • Constipation or diarrhea

What are symptoms of abnormal prolactin production?

Excess prolactin can cause:

  • Menstrual cycle changes in women
  • Loss of sex drive
  • Erectile dysfunction in men
  • Inability to have children
  • Breast growth in men
  • Production of breast milk in women or men
  • Osteoporosis
  • Too little prolactin can prevent a woman from breastfeeding her newborn

What are symptoms of abnormal ACTH production?

Too much adrenocorticotropic hormone (ACTH) can cause:

  • Weight gain, especially in your midsection
  • High blood pressure
  • High blood sugar
  • Osteoporosis, or irritability
  • Easy bruising
  • Acne and increased hair growth
  • Stretch marks on skin  
  • Muscle weakness 

Too little ACTH can cause:

  • Fatigue or low energy
  • Low blood pressure
  • Low blood sugar
  • Upset stomach

What are FSH’s and LH’s symptoms?

FSH and LH are gonadotropin hormones. They are rarely high enough to cause symptoms. In rare cases they can cause infertility, or women may have irregular menstrual cycles, or men can have erectile dysfunction.

Can a pituitary tumor cause vision problems?

Yes, if the tumor is pressing on your optic nerves or the nerves that control eye movements, it can cause:

  • Vision changes
  • Double vision
  • Partial vision loss
  • Blindness
  • Headaches

[would take this below section out – as it is vague and not really accurate ]

A large pituitary tumor (a half inch or larger) can put pressure on your pituitary gland, nearby tissues or organs. Large tumors are more likely to cause:

  • Hormone deficiency
  • Nausea or vomiting
  • Weakness
  • Sexual dysfunction
  • Increased urine
  • Weight changes
  • Feeling cold all the time

Diagnosis

How are pituitary tumors diagnosed?

[WHAT?! – we don’t typically biopsy pituitary tumors. It’s usually biochemical evaluation with labs, and in some inferior petrosal sinus sampling]

NO!! 

A biopsy is the most accurate way to determine the type of tumor and its stage of progression. A small sample of tumor tissue is removed for laboratory testing. Usually done before surgery to remove a pituitary tumor, a biopsy lets the doctor check on the production of each hormone. 

If a biopsy is not possible, other tests can be performed. The type of test will depend on your symptoms, age, general health, and the type of tumor your doctor thinks you have. 

Diagnostic tests for pituitary tumor include:

  • Lab tests measure the amounts of hormones in your blood.
  • MRI can produce detailed images of your body, including soft tissues. It is now the standard diagnostic test.
  • CT scans can provide a three-dimensional image of the tumor and measure its size. 
  • Visual field test if there are eye or vision problems.

Treatments

How will my treatment be determined?

Treatment of pituitary tumors is determined by test results, and by the type and stage of tumor, your overall health, and your treatment preferences. Be sure you understand all your treatment options, and what to expect during treatment. Your treatment should include treatment for uncomfortable symptoms and side effects.

A team of several types of doctors, called a multidisciplinary team, is often involved in treating pituitary tumors. Your treatment team will likely be led by an endocrinologist, a specialist in gland problems and the body’s endocrine system. If you’re having vision problems, an ophthalmologist will be on your team. If surgery is needed, a neurosurgeon will be included. 

Options for treatment can include:

  • “Watchful waiting” is for people who have no symptoms and normal hormones. You’ll have regular exams and/or tests to watch for tumor growth. If it begins to grow, you’ll start active treatment.
  • Surgery is the most common treatment for pituitary tumors. The goal is to remove the entire tumor in an operation. Most (95%) of these surgeries are performed through the nasal passage.
  • Radiation therapy uses high-energy X-rays to destroy tumor cells, called external-beam radiation. This treatment is used when some of the tumor is not removed during surgery or cannot be treated with medications. 

Radiation is very effective in stopping tumor growth, eventually shrinking the tumor. Radiation can cause fatigue, upset stomach and skin reactions in the short term. Long term, it can cause short-term memory problems or cognitive changes. Radiation can cause your pituitary gland to lose the ability to produce hormones, possibly requiring hormone replacement therapy. 

  • Medication to treat pituitary tumors is called systemic therapy. It includes hormone replacement therapy or other drugs. You may receive more than one type of medication, or you may take medications along with surgery or radiation therapy. 

Treatment for aggressive pituitary tumors, or those that have spread to nearby tissue (called locally invasive), or to other parts of the body (called metastatic cancerous tumor) are more likely to benefit from radiation therapy. 

Can a pituitary tumor return after treatment?

Yes, it can recur in the same place, a nearby area, or, rarely, in a distant place. If this happens, it will need to be evaluated again and retested.  

Being diagnosed with a pituitary tumor can be an emotional and scarry experience. You need the best care from highly trained specialists. Call Inland Endocrine today for an appointment with our specialists.

References

Mayo Clinic Staff. 2021. Pituitary Tumors. Patient Care and Health Information. Retrieved 07.01.2021, {https://www.mayoclinic.org/diseases-conditions/pituitary-tumors/symptoms-causes/syc-20350548}

American Association of Neurological Surgeons. N.d. Pituitary Gland and Pituitary Tumors. AANS. Retrieved 07.01.2021, {https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Pituitary-Gland-and-Pituitary-Tumors}

American Society of Clinical Oncology. 2019. Pituitary Gland Tumor: Symptoms and Signs. Cancer.net. Retrieved 07.01.2021,

{https://www.cancer.net/cancer-types/pituitary-gland-tumor/symptoms-and-signs}

American Society of Clinical Oncology. 2019. Pituitary Gland Tumor: Diagnosis. Cancer.net. Retrieved 07.01.2021, {https://www.cancer.net/cancer-types/pituitary-gland-tumor/diagnosis}

American Society of Clinical Oncology. 2019. Pituitary Gland Tumor:Types of Treatment. Retrieved 07.01.2021, {https://www.cancer.net/cancer-types/pituitary-gland-tumor/types-treatment}

Information

Medically reviewed by:

Jodi B. Nagelberg, MD, MHA

Dr. Jodi Nagelberg is an endocrinologist, with board certification in Internal Medicine. She also holds a masters in Health Administration and Policy. She joins TeleMed2U as Endocrinology Director and supports our mission to increase access to healthcare for patients everywhere.

Postgraduate: University of Southern California Sol Price School of Public Policy Los Angeles, CA  Masters, Health Administration and Policy, 2011