Pituitary Tumors

Diagnosis

Pituitary tumors often go unnoticed because their symptoms can be similar to other medical conditions and they grow slowly. Functioning adenomas make hormones, while large tumors are called macroadenomas. Small nonfunctioning microadenomas usually do not cause symptoms and are often found incidentally during imaging exams, such as MRI or CT scans, done for other reasons.

To diagnose a pituitary tumor, your healthcare professional will review your personal and family medical history and conduct a physical exam. Additional tests may include:

• Blood tests to check hormone levels. Too much or too little of certain hormones may indicate a pituitary adenoma. Additional tests may be needed for hormones like cortisol to confirm the source.
• Urine tests to help diagnose tumors making ACTH, which leads to excess cortisol and Cushing disease.
• MRI scan to detect the tumor, determine its size, and locate it precisely.
• CT scan, sometimes used to plan surgery.
• Vision testing, as pituitary tumors can affect peripheral vision.

You may be referred to an endocrinologist, a specialist in hormone disorders, for further evaluation.

Treatment

Many pituitary adenomas do not require treatment. If they do not cause symptoms, monitoring over time may be sufficient. Treatment decisions depend on tumor type, size, location, hormone production, growth, age, and overall health. Goals of treatment include:

• Returning hormone levels to a healthy range
• Preventing further pituitary damage and restoring function
• Relieving or preventing symptoms caused by tumor pressure

Treatment options may include surgery, radiation therapy, medications, or hormone replacement therapy. A multidisciplinary team typically manages care, including neurosurgeons, ENT surgeons, endocrinologists, and radiation oncologists.

Surgery may be suggested if the tumor:

• Presses on the optic nerves
• Causes headaches or facial pain
• Affects hormone levels
• Causes hormone overproduction

Surgical options include:

• Endoscopic transnasal transsphenoidal surgery – removes the adenoma through the nose without external incisions, often the preferred method.
• Transcranial surgery (craniotomy) – used for large tumors or those involving nearby brain tissue or nerves.

Radiation therapy may be used when:

• Surgery cannot completely remove the tumor
• The tumor recurs
• Symptoms persist despite medications

Methods include stereotactic radiosurgery, external beam radiation, intensity-modulated radiation therapy, and proton beam therapy. Side effects can include pituitary hormone changes, vision changes, and possible effects on surrounding tissue.

Medications may manage hormone-producing adenomas or shrink tumors:

• Prolactin-producing tumors: cabergoline, bromocriptine
• ACTH-producing tumors (Cushing disease): ketoconazole, metyrapone, osilodrostat, mifepristone, pasireotide
• Growth hormone-producing tumors: somatostatin analogs (octreotide, lanreotide), pegvisomant

Pituitary hormone replacement may be needed if surgery, radiation, or the tumor itself affects hormone levels.

Watchful waiting may be an option for tumors that do not cause symptoms, with regular monitoring of tumor growth and hormone levels.