Pituitary adenoma (patient information)

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 * Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.; Jinhui Wu, M.D.

Overview
Pituitary adenoma is a type of benign tumors in pituitary gland. The pituitary is considered the "master control gland" of hormone production because it regulates the activity of most other glands in the body. Hormones released by pituitary include vasopressin, oxytocin, growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, luteinizing hormone and prolactin. Although the tumors do not grow very large, they can have a big impact on a person's health. When the tumor becomes larger, it can compress and cause damage to nearby parts of the brain. Symptoms of pituitary adenoma depend on the location of the tumor. Different regional tumor affects different hormones and appear different signs. Usual symptoms include vision loss, overproduction of hormones and hormone deficiency. Diagnostic tests include hormone levels in blood and/or urine samples detection, head computed tomography (CT) scan, head magnetic resonance imaging (MRI) scans and vision and visual fields tests. Treatments include surgery, radiation therapy and medicines.

What are the symptoms?
Most pituitary tumors produce too much of one or more hormones. As a result, symptoms of one or more of the following conditions can occur:


 * Hyperthyroidism
 * Cushing syndrome
 * Gigantism or acromegaly
 * Nipple discharge

Symptoms caused by pressure from a larger pituitary tumor may include:


 * Headache
 * Lethargy
 * Nasal drainage
 * Nausea and vomiting
 * Problems with the sense of smell
 * Visual changes
 * Double vision
 * Drooping eyelids
 * Visual field loss

Rarely, these symptoms may occur suddenly and can be severe.

What are the causes?
The causes of pituitary adenomas are unknown. However, some are part of a hereditary disorder called multiple endocrine neoplasia I (MEN I).

When to seek urgent medical care?
Call your health care provider if you develop any symptoms of a pituitary tumor.

Diagnosis
Your health care provider will perform a physical examination. The provider will note any problems with double vision and visual field, such as a loss of peripheral vision or the ability to see in certain areas.

Endocrine function tests include:


 * Cortisol levels:
 * Dexamethasone suppression test
 * Urine cortisol test


 * Follicle-stimulating hormone (FSH) levels
 * Insulin growth factor-1 (IGF-1) levels
 * Luteinizing hormone (LH) levels
 * Serum prolactin levels
 * Testosterone/estradiol levels
 * Thyroid hormone levels:
 * Free T4 test
 * TSH test

Tests that help confirm the diagnosis include the following:


 * Formal visual field testing
 * MRI of head

Treatment options
Pituitary tumors are usually not cancerous and therefore won't spread to other areas of the body. However, as they grow, they may place pressure on important nerves and blood vessels.

Surgery to remove the tumor is often necessary, especially if the tumor is pressing on the optic nerves, which could cause blindness.

Most of the time, pituitary tumors can be removed through the nose and sinuses. However, some tumors cannot be removed this way and will need to be removed through the skull (transcranial).

Radiation therapy may be used to shrink the tumor, either in combination with surgery or for people who cannot have surgery.

The following medications may shrink certain types of tumors:

Bromocriptine or cabergoline are the first-line therapy for tumors that release prolactin. These drugs decrease prolactin levels and shrink the tumor. Octreotide or pegvisomant is sometimes used for tumors that release growth hormone, especially when surgery is unlikely to result in a cure.

Where to find medical care for cancer?
Directions to Hospitals Treating Pituitary adenoma

What to expect (Outlook/Prognosis)?
If the tumor can be surgically removed, the outlook is fair to good, depending upon whether the entire tumor is removed.

Possible Complications
The most serious complication is blindness. This can occur if the optic nerve is seriously damaged.

The tumor or its removal may cause permanent hormone imbalances. The affected hormones may need to be replaced.