Pituitary Tumours

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Overview

Pituitary tumours happen when the cells present in the pituitary gland begin growing abnormally. In most cases, pituitary tumours are benign, and tumours are asymptomatic and go undiagnosed for the rest of a patient’s life.

Unlike other cancers, these cancers rarely spread to other body parts.

The normal hormone-releasing cells of the pituitary gland may be affected as a pituitary tumour grows. As a result, the pituitary gland may either not produce adequate hormones or produce hormones in excess quantities.

Symptoms

Pituitary tumours may lead to both increased and decreased production of specific hormones, and it is the imbalance in the levels of these hormones that causes various symptoms. Following are the symptoms of tumour growth in the pituitary gland:

Headache
Vision problems – double vision or loss of peripheral vision or even sudden blindness
Extreme fatigue
Numbness and pain in the facial area
Mood changes – irritability, anxiety and depression
Sudden flushing of the face
Nausea and vomiting
Dizziness and confusion
Seizures
Loss of consciousness
Weak muscles and bones
Increased blood pressure
Irregular heartbeat
Unexplained production of breast milk
Changes in the menstrual cycle
Reduced sex drive
Impotence
Infertility
Cushing’s syndrome
Acromegaly (overgrowth of bones) in adults and gigantism (excess growth) in children

Courses

The exact causes of pituitary tumours are unknown. There are very few known risk factors for this condition. Also, there are no lifestyle-related risk factors for pituitary tumours.

Following are the risk factors that are associated with pituitary tumours:

Family History of Pituitary Tumours: In most cases, individuals who are diagnosed with pituitary tumours do not have a family history. However, in a few cases, pituitary tumours are found to run in families.
Certain Genetic Disorders: Having certain inherited genetic disorders can increase one’s risk of developing pituitary tumours.
- MEN1: Multiple endocrine neoplasia type 1 (MEN1) is caused by mutations in the MEN1 gene. This mutation increases the risk of pituitary tumours and other tumours.
- MEN4: Individuals with MEN4 syndrome are more likely to develop pituitary tumours and other tumours.
- Carney Complex: This condition can lead to the formation of a variety of tumours, including pituitary gland tumours.

Diagnosis

These tumours can go undetected for a long time and only be discovered while conducting medical exams for other health issues. In most cases, pituitary tumours are benign. However, it is important for them to be diagnosed in the early stages in order to prevent the possible complications caused by this disease.

Although signs and symptoms may indicate that a person has a pituitary tumour, specific tests are required to confirm the diagnosis. Following are the testing methods recommended for the detection and diagnosis of pituitary tumours:

a. Medical History Assessment and Physical Exam: Before any test, the doctor will thoroughly assess the medical history of the patient for past and underlying medical conditions, previous treatments and allergies. Later, he/she may physically examine the patient for the signs of pituitary tumours.

b. Blood and Urine Analysis: Hormone imbalance is one of the main symptoms of pituitary tumours, and therefore, the doctor may recommend specific blood and urine tests to determine the levels of cortisol, thyroid hormones, luteinizing hormone (LH), etc.

c. Imaging Tests: Imaging tests, namely CT scans and MRI scans, may be recommended by the doctor to determine the exact location and size of the pituitary tumours.

d. Vision Tests: Pituitary tumours often lead to compromised vision, especially peripheral vision. Therefore, the doctor recommends vision tests to study if vision problems are caused due to pituitary tumours.

e. Biopsy: During the biopsy, a small sample of tissue is collected and examined under the microscope for the presence of abnormal cells.

Treatment

Various factors, such as the severity of the symptoms caused due to the pituitary tumours, the size of the tumour, the patient’s age and his/her overall health condition are taken into consideration before planning the treatment for pituitary tumours.

Main treatment options recommended for pituitary tumours include active surveillance, surgery, radiation therapy, drug therapy and hormone replacement therapy. The treatment plan may involve more than one treatment approach depending on the severity of the disease.

a. Active Surveillance: For those with a pituitary gland tumour and show no symptoms and whose hormones are functioning correctly, active surveillance is recommended. The patient is closely monitored throughout with frequent check-ups and testing to look for evidence of tumour growth or progression. Treatments may start once the patient starts showing symptoms.

b. Surgery: Surgery for pituitary tumours may be considered if the tumour is causing serious problems, such as vision loss. There are different surgical approaches employed for the removal of pituitary tumours.

Transsphenoidal Surgery: This is a minimally invasive procedure wherein the tumour is removed by inserting specialised tools through the patient’s nose and sinuses. A camera may be sent along with the specialised tool to get a better view of the tumour during the procedure.
Craniotomy: During a craniotomy, the tumour is removed by making an incision on one of the sides of the patient’s forehead (cranium). A craniotomy is usually recommended for large pituitary tumours.

c. Radiation Therapy: During radiation therapy, high-energy radiation beams are directed at the tumour to destroy it. There are different radiation therapy techniques used to treat pituitary tumours.

External Beam Radiation Therapy: This therapy involves delivering radiation beams to the tumour in tiny doses at regular intervals. This approach takes relatively longer time to shrink the tumour and restore the normal production of hormones.
Stereotactic Radiosurgery: This is an advanced radiotherapy technique wherein the radiation beams are shaped as per the tumour’s size and shape and delivered in high doses. The accuracy is supported by specialised brain-imaging techniques. This approach reduces damage to the surrounding healthy tissues.
Intensity-modulated Radiation Therapy: This radiotherapy technique involves shaping the radiation beams and targeting the tumour from multiple angles. This approach helps in preserving the surrounding healthy tissues while ensuring that the tumour receives maximum radiation.
Proton Beam Therapy: This treatment approach uses high-energy proton beams to kill the tumour cells. Proton beam therapy causes relatively lesser damage to the surrounding healthy tissues.

d. Medications: Specific medications can help in treating the pituitary tumours by stopping the excess production of specific hormones or by shrinking it so that the tumour does not press the pituitary gland or other nerves.

Certain treatments affect the normal production of hormones, and therefore, will need hormone replacement therapy to restore the normal levels of the hormones.

Frequently Asked Questions

1. Are pituitary tumours treatable?

Yes, in most cases, pituitary tumours are non-cancerous and benign. They hardly spread to other organs. Therefore, they can be treated with positive clinical outcomes and excellent survival rates.

However, it is important to note that pituitary tumours can cause certain non-specific symptoms that are easily mistaken for other health conditions. Therefore, any symptoms that last for more than two weeks should not be ignored and brought to the doctor’s attention as early as possible.

2. Do pituitary tumours grow back?

Yes, in some cases pituitary tumours grow back. However, it is possible to treat them successfully.

After receiving the treatment for pituitary tumours, it is important for the patients to keep up their follow-up appointments, which help in reducing the risk of a relapse.

3. Can a pituitary tumour change my personality?

Pituitary tumours alter the levels of various hormones, and this can cause emotional shifts. However, they can be reversed if the tumours are treated on time.

For more information on the impact of pituitary tumours on your personality, please talk to your doctor.

4. What happens if pituitary tumours are left untreated?

Although pituitary tumours are non-cancerous and do not spread to nearby organs in most cases, they interfere with the hormonal balance within the body and thereby affect various bodily functions. Over time, they can cause various problems like vision loss, fatigue, hampered menstrual cycle, infertility, etc.

Therefore, it is important to pay attention to any symptom that lasts for more than two weeks, get it diagnosed appropriately and receive treatment as per the doctor’s advice.

5. Can stress cause pituitary tumours?

A few studies have shown that stress can increase the risk of pituitary tumour formation. However, more research is required on the relationship between stress and pituitary tumours.