Abnormal growths that appear in the pituitary gland are called pituitary tumors. This is a small organ whose size is approximately a pea and it is located at the brain’s base behind the nose. Tumors usually cause the pituitary gland to produce an increased amount of hormones which negatively affects body functions. On the other hand, there are some tumors that provoke this gland to make less hormones.
In most cases, pituitary tumors are benign (noncancerous) also known as pituitary adenomas. Approximately all noncancerous pituitary tumors develop in the pituitary gland or certain tissues that surround it. Commonly, they grow slowly and do not spread to other body tissues and organs.
However, there are different treatment options for pituitary tumors. These include surgery (to remove the tumor), medications to slow down the tumor growth, or radiation therapy. Moreover, physicians may prescribe additional medicines to control hormones along with previous ones.
Pituitary Tumors Types
- Functioning – In such cases, noncancerous tumors produce hormones that lead to different symptoms depending on the hormone they produce. In addition, functioning noncancerous pituitary tumors also are classified in different categories according to the hormone adenomas produce. These include adrenocorticotropic hormone or ACTH (corticotroph adenomas), growth hormone (somatotroph adenomas), luteinizing hormone, follicle-stimulating hormone (gonadotropin adenomas), prolactin, and thyroid-stimulating hormone (thyrotrophic adenomas).
- Nonfunctioning – In such cases, noncancerous tumors do not produce hormones but unusual growths put pressure on the pituitary gland, nerves, and the brain.
- Macroadenomas and Microadenomas– The difference between these tumors is the size of macroadenomas (1 centimeter or even more) and microadenomas (less than 1 centimeter).
Many people cannot understand the difference between pituitary tumors and cysts. A sac filled with air, fluid, or other substance is known as a cyst but a tumor is an abnormal growth (unusual mass) of cells that grows over time.
Symptoms
However, not all pituitary tumors provoke symptoms. Such tumors are usually found during imaging tests (such as MRI or CT) that are done to find other health problems. In most cases, tumors that do not cause symptoms do not require treatment.
Symptoms due to pituitary tumors commonly appear because the adenoma puts pressure on the brain or tissues around it. As a result, symptoms occur due to hormonal imbalance.
The symptoms are classified according to the type and amount of hormones. Check below some examples:
Tumor Pressure Symptoms
Mostly, macroadenomas put pressure on the pituitary gland, nerves, or the brain. Therefore, it causes the following symptoms:
- Headaches
- Drooping eyelid
- Seizures
- Nausea
- Vomiting
- Eye issues (such as side vision loss, double vision, and others)
Hormone Changes Symptoms
Decreased Hormone Levels
The pituitary gland usually cannot produce enough hormones due to macroadenomas. Examples include:
- Nausea
- Feeling cold
- Unusual weight gain or loss
- Menstrual cycle changes
- Sexual problems (including erectile problems, reduced sexual desire, and others)
- Loss of energy
- Tiredness
- Weakness
Increased Hormone Levels
Commonly, functioning pituitary benign tumors make an increased amount of one hormone only. In rare cases, these tumors can produce large amounts of different hormones. As a result, the symptoms appear according to the hormone that is produced more than needed. For example:
Adrenocorticotropic Hormone
These tumors are called corticotroph adenomas. They make adrenal glands produce more Cortisol. Therefore, it may lead to Cushing disease and the following symptoms. Examples include:
- Weight gain (usually around the midsection and upper back)
- Rounded face
- Stretch marks
- Thin skin
- Easy bruising
- Thinning of the legs and arms
- Muscle weakness
- Acne
- Menstrual cycle changes
- Sexual problems
- Delayed wound healing
- Thicker body hair
Growth Hormone
The tumors that cause excessive amounts of growth hormone are known as somatotroph adenomas. In such cases, you may experience a health condition called acromegaly. Check below some symptoms:
- Joint pain
- Deeper voice
- Thicker skin
- Excessive sweating
- Body odor
- Growth of the feet or hands
- Facial features changes (such as large lips, nose, and tongue, longer lower jaw, and others)
In addition, when children or teens have increased amounts of growth hormone, it may lead to gigantism (it means they grow faster or taller than usual).
Luteinizing Hormone and Follicle-stimulating Hormone
Tumors that provoke increased production of these hormones are known as gonadotroph adenomas. In most cases, the symptoms occur due to large tumors but not to increased hormone production. Overproduction of these hormones affects males and females differently. Check below some symptoms in women:
- Infertility
- Pain and enlargement in the ovaries provoked by ovarian hyperstimulation syndrome.
- Menstrual cycle changes
Check below also symptoms that happen in men:
- Increased levels of Testosterone
- Enlarged testicles
Prolactin Hormone
In such cases, tumors are called prolactinomas and they lead to increased production of Prolactin hormone. Thus, it negatively affects sex hormones (such as Estrogen and Testosterone). High amounts of Prolactin also impact different men and women. Check below some symptoms in men:
- Erectile function problems
- Reduced sexual drive
- Decreased body and facial hair
- Fertility problems
- Breast growth
Check some symptoms that occur in females:
- Irregular periods
- Breast tenderness
- Fertility problems
- Loss of libido
- Milky discharge from the breasts
- Lack of menstrual cycle
Thyroid-stimulating Hormone
This benign tumor is called thyrotroph adenoma and it provokes the thyroid gland to produce more Thyroxine hormone (T-4). It usually leads to hyperthyroidism (overactive thyroid gland). As a result, the metabolism speeds up which causes different symptoms For example:
- Nervousness, irritability, or anxiety
- Irregular or fast heartbeat
- Weight loss
- Sweating
- Tremors
- Sleeping disturbances (insomnia)
It is advised to contact your doctor immediately if any of the previous symptoms happen. Furthermore, some pituitary tumors are hereditary (run in families) such as multiple endocrine neoplasia, type 1 (MEN 1).
Causes
The exact cause of pituitary tumors is not known. Rarely, these tumors can develop due to genes. In other words, pituitary tumors can be inherited from biological parents. In any case, more research is needed.
Risk Factors
Approximately all people with pituitary tumors, do not have risk factors that increase the chances of pituitary adenomas. Moreover, lifestyle choices and environmental factors seem to not have negative effects on the risk of pituitary tumors. However, genetics could play a role but most people with these tumors do not have a family history of pituitary adenomas.
In any case, certain rare hereditary diseases can increase your risk of pituitary tumors. For example:
- Multiple endocrine neoplasia, type 1 and type 4 (also known as MEN 1 and MEN 4)
- Carney complex
- McCune-Albright syndrome
Complications
Commonly, these adenomas do not spread to other body parts. However, they can cause serious health problems. Check below some of them:
- Bone loss (osteoporosis)
- Hypertension (high blood pressure)
- Heart problems
- Thinking and memory problems
- Vision disorders (including blindness)
Seizures
This complication occurs usually when a large tumor puts pressure on a certain brain part called the medial temporal lobe. Such seizures usually involve loss of consciousness or awareness and people cannot remember it occurs.
Permanent Reduced Hormone Levels
Either pituitary adenomas or surgery to remove them may cause permanent hormonal production problems. Therefore, those who suffer from this complication often need life-long hormone replacement therapy.
Pituitary Apoplexy
This is a rare but very serious pituitary tumor complication because a sudden bleeding into the adenoma can happen. Check below the most common symptoms:
- Nausea
- Vomiting
- Severe headaches
- Vision problems (including double vision or blindness in one or both eyes)
This is considered a medical emergency and treatment involves Corticosteroids and surgery to remove the tumor.
Diagnosis
In most cases, doctors diagnose these tumors during imaging tests for other health problems. Therefore, if your physician identifies a pituitary tumor but it does not cause any symptoms, you may not need treatment. However, physicians perform the following tests usually to determine whether you have pituitary adenomas or not. Check below some examples:
- Blood Tests – This is a test that helps to measure hormone levels which can indicate you have a pituitary tumor. However, if tests show you have increased Cortisol levels, you may need to do additional tests to confirm the pituitary tumor. Moreover, low hormone levels also require additional imaging tests.
- Urine Tests – This test is usually done to diagnose pituitary tumors that produce increased amounts of ACTH.
- MRI Scan – This is an imaging test that helps to make detailed images of different organs and tissues. It usually helps doctors identify pituitary tumors and their size.
- CT Scan – This is a computed tomography (CT) scan that involves X-rays to produce images of the body’s organs and tissues.
- Vision Test – Commonly, people with pituitary adenomas experience peripheral vision (side vision) problems. Doctors usually perform vision tests to determine if other tests are required to identify the pituitary tumor.
Treatment
Mostly, pituitary adenomas do not require treatment. It means if you experience benign pituitary tumors without symptoms, you do not need treatment. The treatment prescribed by doctors for patients is usually different because it depends on the type, size, and location of the adenoma. Moreover, it also depends if it provokes too much or too little hormone production, your age, and overall health. The treatment goal is to return the hormone levels to a healthy range, prevent permanent damage to the pituitary gland, restore its function, and reduce the symptoms.
The primary treatment option for pituitary tumors is surgery. However, it involves a healthcare team. For example:
- Neurosurgeon (brain surgery)
- ENT surgeon (sinus and nose surgery)
- Endocrinologist (hormone disorder specialist)
- Radiation oncologist (a specialist in radiation therapy)
Surgery
This procedure involves the removal of the tumor. Sometimes, it is called a tumor resection. Commonly, doctors recommend this treatment option if the tumor press on the optic nerves, provoke symptoms such as headaches or facial pain, or reduces or increases hormone production. The outcome of surgery depends on the tumor’s size, location, and if it affects nearby tissues. The most common surgeries used to remove pituitary adenomas include endoscopic transnasal transsphenoidal surgery and craniotomy.
Endoscopic Transnasal Transsphenoidal Surgery
This procedure is sometimes called adenomectomy and it is one of the most common surgeries used to treat pituitary tumors. In such cases, surgeons remove the adenoma through the nose and sinuses and do not involve any external cut. However, if you experience a macroadenoma it may be challenging to remove it using this surgery type, especially if it spreads to nearby tissues (such as nerves, blood vessels, and others).
Transcranial Surgery
This surgery is less frequently used but it is easier for surgeons to remove macroadenomas utilizing this treatment option. During this surgery, doctors will the adenoma is removed through the upper skull part.
Additionally, both surgeries usually do not cause complications or other health problems. However, some people may experience the following complications. Examples include:
- Brain injury
- Adverse reactions to medicines (such as sleepiness)
- Vision changes (such as double vision or even loss of vision)
- Pituitary gland damage
- Bleeding
- Infections
- Temporary nasal congestion and headaches
Radiation Therapy
This treatment option involves high-energy beams that destroy the tumors. Doctors often recommend this therapy when the adenomas spread to nearby tissues or surgery is not an option. This is an effective procedure if the tumor is not removed thoroughly with surgery, returns after surgery, or adenomas cause symptoms and medicines are not effective. Check below some radiation therapy types:
- Stereotactic radiosurgery
- External beam radiation
- Intensity-modulated radiation therapy
- Proton beam therapy
The radiation therapy type is prescribed by the doctors according to the symptoms you experience and the tumor’s size. Moreover, this treatment option can also provoke certain adverse reactions and complications. Examples include:
- Pituitary gland damage
- Damage to the optic nerves
- Elevated risk of a brain tumor
Medicines
Physicians also recommend certain medicines that help to manage pituitary tumors. Check below some examples:
- Cabergoline
- Bromocriptine
- Ketoconazole
- Metyrapone
- Osilodrostat
- Pasireotide
- Octreotide
- Lanreotide
- Pegvisomant
The medicines that doctors prescribe depend on the hormone adenomas produce. Do not administer any of the previous medications without a doctor’s recommendation because it may lead to unpleasant outcomes.
Frequently Asked Questions
What are the main pituitary tumors symptoms?
These include:
- Headaches
- Eye problems (such as loss of side vision, double vision, and others)
- A lump of fat in the back of the neck
- Unusual weight gain
What happens if the pituitary adenomas are not treated?
If you ignore these tumors, it may lead to decreased hormone levels including one or more pituitary hormones, Cortisol, thyroid hormone, and sex hormones (including Estrogen and Testosterone). If you think you have a pituitary tumor, immediately contact your healthcare provider.
What tests are usually performed by doctors to diagnose pituitary tumors?
Healthcare professionals usually perform MRI (magnetic resonance imaging) and CT (computed tomography) scans to diagnose these tumors of the pituitary gland. Ask your doctor if you have additional questions.
