Pituitary Tumors and Related Problems
Pituitary Adenomas and related tumors that arise around the Pituitary Gland are relatively common. The most frequently encountered tumors are Pituitary Adenomas, Rathke’s Cleft Cysts (RCCs) and Craniopharyngiomas. Other tumors that occur in the midline skull base region near the pituitary gland include Meningiomas, Chordomas and Sphenoid Sinus Carcinomas. Other brain tumors that can arise near the pituitary gland include Gliomas and Epidermoid Cysts.
Given their location, tumors in and around the Pituitary Gland can cause significant health problems and disability including abnormal pituitary hormone over-production (e.g., acromegaly – excess growth hormone; Cushing’s disease – excess adrenocorticotropic hormone; prolactinoma – excess prolactin; thyrotropinoma – excess thyroid stimulating hormone), hormonal underproduction (hypopituitarism), loss of vision, headaches and bleeding.
Pituitary tumors and related tumors are best diagnosed by imaging studies, typically magnetic resonance imaging (MRI) or computer tomography (CT) of the brain and pituitary, and pituitary hormonal blood and urine tests.
The optimal treatment for pituitary adenomas and related tumors depends on the tumor type and the resulting symptoms. Treatment often involves Endonasal Endoscopic Surgery, and may also include medical therapy, radiation and/or hormone replacement therapy. Some tumors which are not causing any symptoms but were discovered by virtue of an MRI may require no treatment and can be followed with repeat imaging and hormonal tests. However, most patients with a symptomatic tumor in this area will warrant surgery or some other form of treatment. Consequently, the care of patients with a pituitary tumor is usually coordinated by the Neurosurgeon and an Endocrinologist (a specialist in hormonal disorders). Other specialists involved with treating these problems may include an Head & Neck Surgeon, Ophthalmologist, Oncologist, Radiation Oncologist and Neurologist.
- Minimally Invasive Surgery
Virtually all pituitary adenomas and RCCs as well as most craniopharyngiomas and clival chordomas are removed using Endonasal Endoscopic Surgery (through the nostrils without facial or lip incisions). Occasionally, a craniotomy may be required to remove some craniopharyngiomas and parasellar meningiomas depending upon their growth pattern and location. If a Craniotomy is required, in most instances, a minimally invasive Supra-Orbital “Eyebrow” Craniotomy can be used to reach such tumors.
Some types of Pituitary Adenomas (e.g., Prolactinomas) can also be treated with medications to shrink the tumor and lower abnormally elevated hormone levels. Hormone Replacement Therapy (e.g., cortisol, thyroid, estrogen, testosterone) is often needed as well if pituitary function is lost.
- Radiosurgery and Radiotherapy
Some pituitary adenomas, craniopharyngiomas and other tumors around the pituitary gland that cannot be completely removed surgically are effectively treated with focused radiotherapy using stereotactic radiosurgery (SRS – a single dose of radiation) or stereotactic radiotherapy (SRT – multiple doses).