Spring 2005 Issue

Pituitary Tumors:
Their Symptoms & Treatment
Symptomatic pituitary tumors are uncommon. While more than 99% of pituitary tumors are benign, a pituitary tumor can cause problems due to its size, its production of excessive hormones, or because it causes the pituitary gland to become underactive. Because pituitary tumors can have such a wide range of effects on the body, they often present with what seem to be a long list of unrelated symptoms.

Symptoms
Effects of pituitary tumors vary depending upon the type of tumor, its size, and what area of the pituitary gland is affected.


Common Symptoms Of Pituitary Tumors Include:
• Loss of vision, particularly peripheral vision
• Headache
• Hypothyroidism (low thyroid hormone level)
• Adrenal insufficiency (low cortisol level)
• Hypogonadism (loss of sexual function in men,
loss of menstrual periods or infertility in women)
• Diabetes insipidus (resulting in frequent urination
and excessive thirst)

In addition to the the symptoms listed above, specific types of tumors cause other changes in body function as a result of excessive hormone secretion from the tumor.

Prolactinoma
This is the most common type of pituitary tumor and is associated with the secretion of excess prolactin. In men this tumor most commonly causes loss of sexual function, infertility, and enlargement of the breasts. Women who have not reached menopause may experience lactation, a change in menstrual periods, or loss of menses or infertility. Headache and loss of vision may be the first indicator of a prolactinoma for menopausal women.

Acromegaly
These pituitary tumors are associated with excessive growth hormone secretion. The most common symptoms are excessive sweating, and enlargement of the hands, feet and face. Other problems include joint pains, sleep apnea, hypertension, diabetes mellitus, colon polyps, change in teeth spacing, oily skin and acne.

Cushing's Disease
This tumor produces an excessive amount of the hormone ACTH, leading to overproduction of cortisol by the adrenal glands. The result is weight gain (particularly in the abdomen and neck), loss of muscle mass in the legs and arms, muscle weakness, depression, thinning of the skin with easy bruising, hypertension, diabetes mellitus, osteoporosis with a risk for bone fractures, and weakening of the immune system.

Diagnosis & Treatment
In addition to a complete medical history and medical examination, the first step to diagnosing the presence of a pituitary tumor is the measurement of hormone levels in the blood. CT and MRI can then confirm the exact location and size of the tumor.

Using the transsphenoidal approach for pituitary tumor removal avoids the need for a craniotomy and usually requires only a few days of hospitalization.
Treatment can include the use of bromocriptine, hormone-replacement therapy, radiation therapy, and surgery. For many patients, surgical removal of the tumor can result in dramatic and immediate relief from some symptoms. Typically, surgical care does not require a craniotomy. Instead, the preferred approach involves a transsphenoidal route (through the nose and across the sphenoid sinus of the face), resulting in no noticeable facial scar. The surgery involves some moderate facial discomfort, but is extremely well tolerated. Best of all, the entire process usually requires only a few days of hospitalization for the patient.

TSH Secreting Tumor
The least common type of hormone-producing pituitary tumor, the excessive TSH causes hyperthyroidism. Symptoms include weight loss, nervousness, rapid heartbeat, difficulty sleeping, frequent bowel movements, and scarce menstrual periods for women.

Non Secretory Tumor
These pituitary tumors do not produce an excessive amount of a pituitary hormone and are usually detected after they become large, causing loss of vision and/or headache and/or hypothyroidism or adrenal insufficiency. Non Secretory tumors most commonly cause sexual dysfunction in men and loss of regular menses in premenopausal women.

Craniopharyngioma/Rathke’s Cleft Cyst
These tumors are congenital and may cause hypopituitarism and/or diabetes insipidus.

Pituitary Cyst
The most common symptoms of this condition are headache and, if the cyst is large, loss of vision and loss of normal pituitary function.


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