Pituitary Tumors Program

Why Choose Us?

We offer every patient a dedicated team of medical experts to support them, and their family, throughout their treatment journey. Our integrated approach includes a vast team of endocrinologists, neuro-radiologists, interventional neuro-radiologists, neuro-rehabilitation specialists, ophthalmologists, researchers, clinical care coordinators and nurses, all working together to offer the best personalized science and technology, one patient at a time. The multidisciplinary team meets daily to discuss each patient’s needs, their progress and to decide the best treatment plan.

What We Treat

A pituitary tumor or adenoma is a growth on the pituitary gland, which is located at the base of the brain and is responsible for hormone production that regulates many important functions in the body. Most pituitary tumors are benign (not cancer) and grow slowly. This means they do not spread to other parts of the body. Pituitary adenomas can be classified based on their size into microadenomas (< 1 cm) and macroadenomas (> 1 cm).

Types of Pituitary Adenomas

Non-functioning pituitary tumors

• These tumors do not produce hormones. They can still cause problems by compressing nearby structures such as the optic nerves/chiasm causing visual loss or compressing the normal pituitary gland and impair normal hormone production.

Functioning pituitary tumors

• These tumors produce hormones in excess, leading to specific symptoms depending on the type of hormone produced. Common types include:
  • Prolactinomas: Tumors that produce prolactin, which can cause abnormal milk production (galactorrhea) and irregular menstrual cycles in women, and erectile dysfunction or decreased libido in men.
  • Growth hormone-producing tumors (Acromegaly): These tumors cause excessive growth hormone production, leading to enlargement of the hands, feet, and facial features, as well as other health problems.
  • ACTH-producing tumors (Cushing's disease): These tumors cause excessive production of adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol. This can result in weight gain, high blood pressure, diabetes, and other symptoms.

Symptoms, Causes & Risk Factors

The symptoms of pituitary tumors vary depending on its mass effect and whether hormones are released. General symptoms include:

• Headaches: Often dull and persistent, especially if the tumor is large and causing pressure within the skull. Can be associated with nausea and vomiting.
• Vision Problems: Particularly loss of peripheral vision (bitemporal hemianopsia) due to compression of the optic nerves or optic chiasm. Occasionally it can cause double vision due to pressure on the nerves responsible for eye movement.
• Hormonal imbalances:
  • Abnormal milk production (galactorrhea)
  • Irregular menstrual cycles in women
  • Infertility
  • Erectile dysfunction or decreased libido in men
• Enlargement of the hands, feet, and facial features
• Weight gain
• Acne
• Achy joints or muscle weakness/wasting
• Fatigue

Causes & Risk Factors for Pituitary Tumors

Most pituitary tumors occur sporadically and are not inherited. Sporadic mutations in the DNA of pituitary cells may lead to abnormal cell growth and tumor formation.

In rare cases, certain genetic syndromes are associated with an increased risk of pituitary tumors. These include:

• Multiple endocrine neoplasia type 1 (MEN1)
• Carney complex
• Familial isolated pituitary adenoma (FIPA)

Diagnosis & Treatment

Diagnosis of Pituitary Tumors

If a pituitary tumor is suspected by your doctor, they will review all your symptoms and medical history and perform a thorough physical exam. A detailed eye examination including visual acuity and visual field testing may need to be performed. Blood tests will be done to check your hormone levels. Imaging with a pituitary MRI can identify any form of growth on the pituitary gland.

Treatment of Pituitary Tumors

Surgery, medication, radiation or any combination of these treatments are usually offered to people with pituitary tumors.

• Surgery: Most pituitary tumors can be removed with endoscopic endonasal transsphenoidal surgery. It is performed through the nose and sphenoid sinus, without making an external incision. The surgeon removes the tumor under endoscopic visualization, while preserving the normal pituitary gland and the surrounding structures. This surgery is typically performed by two surgeons (Neurosurgery and ENT). Occasionally, the tumor cannot be completely removed from the nose and a craniotomy would be required.
• Medication: Drugs may be prescribed to control hormone levels and reduce tumor size, especially for functioning pituitary tumors:
• Prolactinomas: Dopamine agonists to reduce prolactin secretion and shrink the tumor.
• Acromegaly: Somatostatin analogs or growth hormone receptor antagonists to lower growth hormone levels and control symptoms.
• Cushing's Disease: Medications such as cabergoline, somatostatin analogs, or adrenal enzyme inhibitors to lower cortisol levels and manage symptoms.
• Radiation:

• Stereotactic Radiosurgery (SRS): This technique delivers precise, high-dose radiation to the tumor while sparing surrounding tissues. It is often used for small, residual, or recurrent tumors that cannot be completely removed with surgery.
• Conventional external beam radiation therapy: This may be used in some cases for larger tumors or when SRS is not feasible.

• Observation and monitoring: For small, asymptomatic tumors, especially non-functioning adenomas, periodic monitoring with MRI scans may be recommended to track tumor growth and assess for any development of symptoms.

Prevention & Screening

Pituitary tumors have not been linked to any specific known risk factors. At present, there is no known way to prevent them.

For patients with pituitary tumors and a suspected genetic syndrome, genetic testing can be performed to confirm the presence of a genetic mutation and for counseling.

Program Caregivers

Our Pituitary Tumors Program doctors have extensive expertise in the field of pituitary adenomas, and provide excellent, Patients First medical care based on current US and international guidelines. Caregivers involved in patient care for this program includes:

• Neurosurgeons
• Endocrinologist
• Neuro-ophthalmologist
• ENT Surgeons
• Radiation oncologists
• Neuropathologists
• Neuro-radiologists
• Interventional neuro-radiologist