Pituitary Tumors

Most pituitary tumors (adenomas) are not cancerous. Yet, because they affect what’s sometimes called the “master gland,” they can dramatically impact your health and well-being.

Located at the base of the brain, the pea-sized pituitary gland tells the other glands to release hormones and helps regulate growth and development.

Each year at the University of Maryland Medical Center, we diagnose and/or treat hundreds of these skull base tumors, which affect people of all ages, genders and races.

Our pituitary tumor team, which has experts from a range of specialties, treats pituitary and neuroendocrine tumor patients with comprehensive and innovative care, using the most advanced technology and a patient-centered approach.

Diagnosis

Pituitary tumors are found in approximately 15 percent of individuals during autopsy studies — even when they’ve never triggered symptoms. Typically diagnosis only happens after a patient has noticed certain signs, which range from mild to severe.

Three common patterns that lead to diagnosis are:

• Hormone imbalance: The pituitary gland controls hormones affecting functions such as growth, metabolism and the production of eggs, sperm, breast milk and cortisol. The pressure of a tumor could disrupt any of these processes, causing a variety of symptoms.
• Headaches: During a medical workup for frequent headaches — which may be due to migraines or other causes besides a tumor — a tumor may be discovered.
• New vision loss: A tumor can prompt vision loss or double vision as it presses on optic nerves.

Regardless of the symptoms that lead to its discovery, pituitary tumors are usually visioned with imaging scans such as CT or more commonly MRI. In addition, lab tests are used to detect changes in hormone levels.

Effects of Pituitary Tumors

The effects can vary widely based on which hormones they effect and whether they cause increased or lowered levels of them.

Typically, they cause a gland to overproduce hormones. However, they can also result in lower levels of certain hormones. The overproduction of one hormone can cause decreased levels of another, or the tumor can disrupt a hormone's production.

Some types include:

• ACTH-producing tumors trigger the adrenal glands to produce cortisol, sometimes called the “stress hormone.”
• Prolactinomas overproduce the hormone prolactin causing decreased levels of estrogen in women and testosterone in men.
• TSH-producing tumors can cause an overactive thyroid. But pituitary tumors can also disrupt the production of TSH, which triggers an underactive thyroid, called secondary hypothyroidism.
• Growth hormone-secreting tumors cause acromegaly, a rare condition where the body or some parts of it to grow abnormally large.
• Gonadotropin-secreting tumors often present with headaches and visual changes and are usually larger than 10 mm. They can cause irregular menstrual periods in women or low testosterone levels in men.
• Nonfunctional pituitary tumors, which don’t secrete any hormones, account for 25-30 percent of these types of tumors. Because they don't cause hormonal imbalances, they often aren't detected until they grow large enough to put pressure on the surrounding tissues.

Treatment Options

Not all pituitary tumors require treatment, particularly if they are not causing symptoms. When they do require treatment, surgery is often the choice. However, sometimes radiation or medication is the best option.

New MRI methods, utilized by our tumor specialists, can help predict which pituitary tumors are better candidates for certain surgical approaches or other treatments.

After surgery, patients may need to take hormone replacement medications.

Surgery

A neurological problem such as vision loss usually indicates a surgical approach, but a tumor that is clearly growing or causing a hormone imbalance could as well. Typically, surgeons surgically remove the tumor through the nasal passage.

Radiation

In some cases, when surgery is high-risk or with recurrent tumors, we use radiation.

When radiation therapy recommended, UMMC patients have access to proton therapy, a highly advanced and precise form of radiation at the Maryland Proton Treatment Center (MPTC). Called pencil beam scanning, this technology delivers powerful beams directly to tumors, protecting sensitive nearby tissues.

UMMC’s Gamma Knife Center offers patients with some pituitary tumors the option for a non-invasive, precise dose of radiation that carries fewer side effects than traditional radiation treatments. 

Monitoring and Medication

Some tumors may just need monitoring or medications to halt their growth. In particular, prolactin-secreting tumors may respond well to medical management with dopamine-related drugs.

Also those that produce cortisol and growth hormones may respond to medications.