Pituitary Tumors

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Jimmy Santana, MBA, P.A.-CJimmy Santana, MBA, P.A.-C
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tumors develop in the pituitary gland are:tumors develop in the pituitary gland are:
 usually small, usually small,
localized, localized,
slow-growing masses that start in one type of slow-growing masses that start in one type of
hormone-producing pituitary cells.hormone-producing pituitary cells.
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Although these tumors almost always are Although these tumors almost always are
benign (noncancerous), they have the potential benign (noncancerous), they have the potential
to cause significant symptoms by:to cause significant symptoms by:
Producing too much of one of the pituitary Producing too much of one of the pituitary
hormoneshormones
Suppressing the normal function of other cells in Suppressing the normal function of other cells in
the pituitary glandthe pituitary gland
Growing large enough to press on the nearby optic Growing large enough to press on the nearby optic
nerves or on parts of the brain itselfnerves or on parts of the brain itself
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A pituitary tumor is classified as one of four A pituitary tumor is classified as one of four
main types, based on whether it overproduces main types, based on whether it overproduces
pituitary hormones and the specific type of pituitary hormones and the specific type of
hormone produced:hormone produced:
nACTH-producing tumorACTH-producing tumor
nProlactin-producing tumorProlactin-producing tumor
nGrowth hormone-producing tumorGrowth hormone-producing tumor
nNon-functioning pituitary tumorNon-functioning pituitary tumor
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ACTH-producing tumorACTH-producing tumor
This pituitary tumor, which also is called a This pituitary tumor, which also is called a
basophilic adrenocorticotrophic hormone-basophilic adrenocorticotrophic hormone-
secreting adenoma, overproduces secreting adenoma, overproduces
adrenocorticotrophic hormone (ACTH). adrenocorticotrophic hormone (ACTH).
ACTH is the pituitary hormone that regulates ACTH is the pituitary hormone that regulates
hormone production by the adrenal gland. hormone production by the adrenal gland.
This type of pituitary tumor releases too much This type of pituitary tumor releases too much
ACTH into the bloodstream, ACTH into the bloodstream,
the extra ACTH overstimulates the adrenal glands the extra ACTH overstimulates the adrenal glands
to pour out high levels of adrenal glucocorticoids to pour out high levels of adrenal glucocorticoids
(adrenal hormones) and androgens (male (adrenal hormones) and androgens (male
hormones) into the blood. hormones) into the blood.
In most cases, an ACTH-producing tumor is small In most cases, an ACTH-producing tumor is small
and doesn't grow beyond the sella turcica.and doesn't grow beyond the sella turcica.
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SymptomsSymptoms
This tumor causes symptoms of Cushing's disease, a This tumor causes symptoms of Cushing's disease, a
condition caused by prolonged overproduction of condition caused by prolonged overproduction of
adrenal glucocorticoids and androgens. adrenal glucocorticoids and androgens.
include trunal obesity include trunal obesity
thin skin, thin skin,
easy bruising, easy bruising,
red or purple lines (striae) on the skin of the abdomen, red or purple lines (striae) on the skin of the abdomen,
a moon-shaped face, a moon-shaped face,
muscle wasting, muscle wasting,
excess body hair in women, excess body hair in women,
acne,acne,
amenorrhea amenorrhea
psychiatric symptoms, such as depression and psychosis.psychiatric symptoms, such as depression and psychosis.
 Cushing's disease also can trigger osteoporosisCushing's disease also can trigger osteoporosis,, hypertension hypertension
and diabetes.and diabetes. 6

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TreatmentTreatment
transsphenoidal hypophysectomy: In this transsphenoidal hypophysectomy: In this
procedure, the surgeon removes the pituitary procedure, the surgeon removes the pituitary
tumor through an incision in the upper portion tumor through an incision in the upper portion
of the nasal passages. of the nasal passages.
After surgery, levels of glucocorticoid hormones After surgery, levels of glucocorticoid hormones
are abnormally low, so the patient typically needs are abnormally low, so the patient typically needs
to take supplemental glucocorticoid medication for to take supplemental glucocorticoid medication for
about 3 to 12 months. about 3 to 12 months.
This medication gradually is tapered as the body This medication gradually is tapered as the body
slowly reestablishes a normal working relationship slowly reestablishes a normal working relationship
between the pituitary gland and the adrenal glands. between the pituitary gland and the adrenal glands.
If the tumor cannot be completely removed by If the tumor cannot be completely removed by
surgery, surgery, radiation therapyradiation therapy may be needed. may be needed.
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Prolactin-producing tumorProlactin-producing tumor
This prolactin-secreting adenoma This prolactin-secreting adenoma
overproduces the hormone prolactin, which overproduces the hormone prolactin, which
stimulates the breasts to make milk. stimulates the breasts to make milk.
Prolactin-producing pituitary tumors can Prolactin-producing pituitary tumors can
develop in both men and women, and develop in both men and women, and
they sometimes grow so big that they press on they sometimes grow so big that they press on
the sella turcica and cause it to get larger.the sella turcica and cause it to get larger.
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SymptomsSymptoms
occasionally causes galactorrhea. occasionally causes galactorrhea.
Much more often, it causes amenorrheaMuch more often, it causes amenorrhea
 In men, it causes impotence and decreased sex In men, it causes impotence and decreased sex
drive.drive.
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TreatmentTreatment
Treatment is determined by the size of the tumor and Treatment is determined by the size of the tumor and
how much prolactin is being produced. how much prolactin is being produced.
Small tumors sometimes don't need to be treated and Small tumors sometimes don't need to be treated and
can be monitored to see if they change. can be monitored to see if they change.
If treatment is necessary, one of the drugs (long-acting If treatment is necessary, one of the drugs (long-acting
dopamine agonists) can be used:dopamine agonists) can be used:
Bromocriptine (Parlodel), Bromocriptine (Parlodel),
Pergolide (Permax) or Pergolide (Permax) or
Cabergoline (Dostinex). Cabergoline (Dostinex).
These drugs reduce blood levels of prolactin and often These drugs reduce blood levels of prolactin and often
shrink the size of the pituitary tumor. shrink the size of the pituitary tumor.
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If a prolactinoma is large or produces high levels of If a prolactinoma is large or produces high levels of
prolactin, surgery may be recommended. prolactin, surgery may be recommended.
Surgery also may be needed if medications don't help or Surgery also may be needed if medications don't help or
the person can't take the medications long term because the person can't take the medications long term because
of side effects. of side effects.
When surgery is needed, the tumor is removed with a When surgery is needed, the tumor is removed with a
procedure called transsphenoidal hypophysectomy. procedure called transsphenoidal hypophysectomy.
In rare cases, In rare cases, radiation therapyradiation therapy may be needed. may be needed.
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Growth hormone-producing tumorGrowth hormone-producing tumor
This tumor, also is called an eosinophilic growth This tumor, also is called an eosinophilic growth
hormone-secreting adenoma, secretes abnormally hormone-secreting adenoma, secretes abnormally
large amounts of growth hormone. large amounts of growth hormone.
In children and teenagers, this overproduction of In children and teenagers, this overproduction of
growth hormone causes a condition called growth hormone causes a condition called
giantism .giantism .
In adults, it causes a condition called acromegaly In adults, it causes a condition called acromegaly
(abnormal enlargement of the skull, jaw, hands (abnormal enlargement of the skull, jaw, hands
and feet, and other symptoms of abnormal and feet, and other symptoms of abnormal
growth). growth).
Growth hormone-producing tumors can grow Growth hormone-producing tumors can grow
beyond the sella turcica.beyond the sella turcica.
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SymptomsSymptoms
If this tumor develops before puberty, then the If this tumor develops before puberty, then the
child typically has the following symptoms of child typically has the following symptoms of
giantism (also called gigantism): giantism (also called gigantism):
abnormally rapid growth, abnormally rapid growth,
unusually tall stature, unusually tall stature,
a very large head, a very large head,
coarse facial features, coarse facial features,
very large hands and feet, very large hands and feet,
and sometimes, behavioral and visual problems. and sometimes, behavioral and visual problems.
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If the tumor develops after puberty, then the person If the tumor develops after puberty, then the person
has the following symptoms of acromegaly: has the following symptoms of acromegaly:
thick, thick,
oily skin; oily skin;
coarse features with thick lips and a broad nose;coarse features with thick lips and a broad nose;
prominent cheekbones; prominent cheekbones;
a protruding forehead and lower jaw; a protruding forehead and lower jaw;
a deep voice; a deep voice;
enlargement of the hands and feet; enlargement of the hands and feet;
a barrel-shaped chest; a barrel-shaped chest;
excessive sweating; and pain and stiffness in the joints.excessive sweating; and pain and stiffness in the joints.

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TreatmentTreatment
Transsphenoidal hypophysectomy is usually the Transsphenoidal hypophysectomy is usually the
first choice, often followed by medical therapy first choice, often followed by medical therapy
with a somatostatin analog to control with a somatostatin analog to control
symptoms. symptoms.
Radiation therapy is used in people who do not Radiation therapy is used in people who do not
respond to surgery or medication.respond to surgery or medication.
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Non-functioning pituitary tumorNon-functioning pituitary tumor
This type of pituitary tumor is an hormonally This type of pituitary tumor is an hormonally
inactive adenoma.inactive adenoma.
It is slow to produce symptoms. For this It is slow to produce symptoms. For this
reason, this type of tumor tends to grow large reason, this type of tumor tends to grow large
before it is discovered. before it is discovered.
In many cases, a nonfunctioning pituitary In many cases, a nonfunctioning pituitary
adenoma is diagnosed only when it already has adenoma is diagnosed only when it already has
grown beyond the sella turcica and has begun grown beyond the sella turcica and has begun
to cause problems related to pressure on the to cause problems related to pressure on the
optic nerves or brain.optic nerves or brain.
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SymptomsSymptoms
These tumors do not produce excessive These tumors do not produce excessive
amounts of hormone. They may be found:amounts of hormone. They may be found:
Accidentally when magnetic resonance imaging Accidentally when magnetic resonance imaging
(MRI) of the brain is done for other reasons(MRI) of the brain is done for other reasons
If they get large enough to affect the production If they get large enough to affect the production
of other pituitary hormonesof other pituitary hormones
If they grow beyond the sella turcica and are If they grow beyond the sella turcica and are
causing pressure on the brain or optic nervescausing pressure on the brain or optic nerves

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Prolactin-producing tumors and nonfunctioning Prolactin-producing tumors and nonfunctioning
tumors can depress the pituitary's ability to make and tumors can depress the pituitary's ability to make and
release other hormones. release other hormones.
Sex hormones usually are depressed first followed Sex hormones usually are depressed first followed
by thyroid hormone and then adrenal hormones. by thyroid hormone and then adrenal hormones.
Symptoms related to low sex hormone levels include: Symptoms related to low sex hormone levels include:
loss of sexual drive, loss of sexual drive,
erectile dysfunction and absence of menstrual erectile dysfunction and absence of menstrual
periods. periods.
If a tumor keeps growing, the person may develop If a tumor keeps growing, the person may develop
fatigue and lightheadedness because the thyroid and fatigue and lightheadedness because the thyroid and
adrenal glands aren't functioning properly.adrenal glands aren't functioning properly.

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Good history must be obtained, including Good history must be obtained, including
current medicationscurrent medications
This information is very important because This information is very important because
certain medical conditions and/or prescription certain medical conditions and/or prescription
drugs can have significant effects on your drugs can have significant effects on your
levels of body hormones. levels of body hormones.
For example:For example:
 psychiatric drugs - neuroleptics can increase psychiatric drugs - neuroleptics can increase
blood levels of prolactin, and blood levels of prolactin, and
prescription glucocorticoids (even therapeutic prescription glucocorticoids (even therapeutic
injections of dexamethasone — Decadron and injections of dexamethasone — Decadron and
other brand names — into injured joints) can cause other brand names — into injured joints) can cause
high blood levels of glucocorticoids.high blood levels of glucocorticoids.

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TreatmentTreatment
Many do not treat nonfunctioning pituitary tumors if the tumor Many do not treat nonfunctioning pituitary tumors if the tumor
is less than 10 millimeters in diameter. Instead, they monitor is less than 10 millimeters in diameter. Instead, they monitor
the growth of the tumor with periodic MRI scans. the growth of the tumor with periodic MRI scans.
Larger tumors are removed surgically using a transsphenoidal Larger tumors are removed surgically using a transsphenoidal
hypophysectomy, sometimes followed by radiation therapy to hypophysectomy, sometimes followed by radiation therapy to
eliminate any remaining tumor.eliminate any remaining tumor.
However, not all pituitary tumors can be removed by using this However, not all pituitary tumors can be removed by using this
surgical approach, either because the tumor is too large or because it is surgical approach, either because the tumor is too large or because it is
in a position that is difficult to reach through the nose. Instead, the in a position that is difficult to reach through the nose. Instead, the
surgeon must do a procedure called a craniotomy, which removes the surgeon must do a procedure called a craniotomy, which removes the
tumor through an incision in the front portion of the skull.tumor through an incision in the front portion of the skull.

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PrognosisPrognosis
ACTH-producing tumorACTH-producing tumor
After surgery, the cure rate is 80% to 90% for ACTH-After surgery, the cure rate is 80% to 90% for ACTH-
producing tumors that have not enlarged beyond the sella producing tumors that have not enlarged beyond the sella
turcica. turcica.
If the tumor cannot be completely removed surgically, If the tumor cannot be completely removed surgically,
radiation therapy is often successful.radiation therapy is often successful.
Prolactin-producing tumorProlactin-producing tumor
Medical treatment is safe and effective in the great Medical treatment is safe and effective in the great
majority of cases, even when the tumor is fairly large. majority of cases, even when the tumor is fairly large.
In women of childbearing age whose periods disappear In women of childbearing age whose periods disappear
because of a prolactin-producing pituitary tumor, medical because of a prolactin-producing pituitary tumor, medical
treatment often restores fertility. treatment often restores fertility.
When surgery is needed, success rates are very high.When surgery is needed, success rates are very high.

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Growth hormone-producing tumorGrowth hormone-producing tumor
Approximately 60% of tumors can be cured with Approximately 60% of tumors can be cured with
surgery. surgery.
In people treated medically, octreotide relieves In people treated medically, octreotide relieves
symptoms in most cases.symptoms in most cases.
Non-functioning pituitary tumorNon-functioning pituitary tumor
The outlook depends on the size of the tumor. The outlook depends on the size of the tumor.
People with small tumors that do not need People with small tumors that do not need
immedaite treatment or can be completely immedaite treatment or can be completely
removed with surgery have an excellent prognosis. removed with surgery have an excellent prognosis.
Even for large tumors that interferre with vision, Even for large tumors that interferre with vision,
surgery can stop further deterioration of vision.surgery can stop further deterioration of vision.

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ANY QUESTIONS?ANY QUESTIONS?