Neurology and Neurosurgery

When do you need surgery for a pituitary tumor?

A male doctor examines a female patient’s eyes with a light in a medical office. There is a photo of a brain on the wall. Pituitary tumors ar a type of brain tumor and can cause vision problems.

08/16/2024

Find out when surgery is necessary for pituitary tumors, the types of procedures available and what to expect after treatment.

 

By David Penn, MD, Neurosurgery, Nuvance Health

 

If a pituitary tumor is causing symptoms that are affecting your life, you might be wondering what treatment options are available. While some people don’t have any symptoms of a pituitary tumor, others can have changes to important bodily functions, headaches or vision problems. In these cases, surgery may be an option to remove the tumor and relieve symptoms.

 

Here’s what you need to know about pituitary tumors, when surgery may be necessary and what to expect during recovery.

 

 

What is a pituitary tumor?

 

Pituitary tumors are abnormal growths in the pituitary gland, a small but significant part of your brain. The pituitary gland plays a crucial role in regulating hormones throughout the body. Tumors can disrupt the gland’s normal functions, leading to various symptoms. Keep reading to find out common symptoms of pituitary tumors.

 

Most pituitary tumors are pituitary adenomas, which are benign (non-cancerous) and slow growing. While the word “tumor” can sound alarming, it’s important to know that pituitary adenomas are generally not life-threatening and can often be managed effectively with proper treatment.

 

 

Are pituitary tumors common?

 

Pituitary tumors are relatively uncommon, affecting more than 10,000 people each year in the United States. Tumors from the pituitary gland are the third most common brain tumor in adults over age 40. Despite this fact, many cases go undiagnosed because they often don’t cause noticeable symptoms. Some research suggests about 25% of people may have small pituitary adenomas and do not know it. When pituitary tumors cause symptoms, they can often be managed with medication, surgery or a combination of treatments.

 

Learn more about pituitary tumors.

 

What does the pituitary gland do?

 

The pituitary gland, often referred to as the “master gland,” is a pea-sized organ located at the base of the brain. It plays a key role in regulating the body’s hormone production and distribution, influencing physiological processes such as:

 

  • Growth: The pituitary gland produces growth hormone, which is essential for physical development.

 

  • Metabolism: The pituitary gland releases thyroid-stimulating hormone (TSH), which controls the thyroid gland’s hormone production.

 

 

  • Reproduction: The pituitary gland secretes hormones that regulate reproductive processes, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

 

  • Stress response: The pituitary gland produces adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to release cortisol, a hormone crucial for stress response.

 

 

Given the pituitary gland’s effect on many important functions in the body, disruptions caused by a tumor can lead to a wide range of symptoms, making early diagnosis and treatment important.

 

What are the symptoms of a pituitary tumor?

 

Pituitary tumors can cause a wide range of symptoms, depending on their size and whether they affect hormone production. Because these tumors grow slowly, the symptoms can often be subtle and develop gradually, making them easy to overlook. Here’s what to watch out for:

 

Hormonal symptoms of a pituitary tumor

 

Pituitary tumors can disrupt the normal hormone balance in your body. This disruption can lead to a variety of symptoms, including:

 

  • Changes in sexual health: Women may experience irregular or absent periods, while men may notice a decrease in libido or erectile dysfunction.

 

  • Unexplained weight changes: Rapid weight gain or loss without changes in diet or activity levels can be a sign of a pituitary tumor.

 

  • Growth abnormalities: In children, pituitary tumors can lead to excessive growth (gigantism), while in adults, they can cause acromegaly, which can cause enlarged hands, feet and facial features.

 

  • Fatigue and weakness: Hormonal imbalances can lead to general feelings of tiredness and weakness.

 

  • Mood changes: Symptoms such as depression, anxiety or mood swings may occur, especially in conditions like Cushing's disease, where cortisol levels are elevated.

 

Physical symptoms of a pituitary tumor

 

A pituitary tumor can cause the following physical symptoms:

 

  • Headaches: Persistent or severe headaches are a common symptom, often due to the pituitary tumor pressing on surrounding tissues.

 

 

  • Vision problems: Pituitary tumors pressing on the optic nerves can cause vision issues, such as blurred or double vision, loss of peripheral vision or sudden vision loss.

 

  • Nausea and vomiting: These symptoms can occur if the pituitary tumor affects the normal functioning of the brain and its surrounding structures.

 

Pituitary tumor symptoms due to compression of nearby structures

 

As pituitary tumors grow, they can exert pressure on nearby structures within the brain, leading to:

 

  • Joint and muscle pain: This can be due to hormonal imbalances affecting the bones and muscles.

 

  • Thirst and urination changes: Increased thirst and urination can occur if the pituitary tumor affects the production of antidiuretic hormone (ADH).

 

Recognizing these symptoms early can lead to a quicker diagnosis and treatment. If you’re experiencing any of these symptoms, especially in combination, it’s important to consult a healthcare provider for a thorough evaluation. You can always start with your primary care provider for an initial evaluation. They may connect you with an endocrinologist or neurosurgeon for further evaluation.

 

 

When is surgery necessary for a pituitary tumor?

 

Surgery for a pituitary tumor becomes necessary in several situations, particularly when the tumor causes troubling symptoms or health risks. Surgery may be recommended if you are experiencing any of these symptoms or circumstances:

 

  • Vision problems: A growing pituitary tumor can press on the optic nerves, leading to blurred or double vision, or even loss of peripheral vision. These symptoms often signal the need for surgical intervention to prevent permanent damage.

 

  • Hormonal imbalances: Some pituitary tumors produce excess hormones, causing conditions like:

 

  • Cushing’s disease: High levels of cortisol can cause symptoms such as rapid weight gain, high blood pressure, diabetes and mood changes.

 

  • Acromegaly: Caused by excess growth hormone, leading to enlarged hands and feet, facial changes, joint pain and other complications.

 

  • Unresponsive to medication: While medications can manage certain pituitary tumors, they aren’t always effective. For instance, dopamine agonists like cabergoline or bromocriptine can treat prolactinomas, while somatostatin analogs (octreotide) can help with growth hormone-secreting tumors. If these medications fail to control the tumor’s growth or hormone production, surgery may be the best next option.

 

Your pituitary tumor doctor will evaluate these factors and recommend surgery if it offers the best chance for a good outcome.

 

What are the types of surgery for pituitary tumors?

 

Several surgical approaches are available for treating pituitary tumors, with the choice depending on the tumor’s size, location and the individual’s overall health. 

 

One of the most effective techniques is endoscopic transsphenoidal surgery, performed by a team including a neurosurgeon and an otolaryngologist (ear, nose and throat (ENT) specialist). This minimally invasive procedure involves accessing the pituitary tumor through the nasal passage. A small camera and instruments are inserted through the nose, eliminating the need for external incisions. This approach provides direct access to the tumor while minimizing trauma to surrounding brain tissue.

 

Benefits of endoscopic pituitary tumor surgery

 

Endoscopic pituitary tumor surgery offers the following benefits:

 

  • Faster recovery time: Individuals typically recover faster compared to traditional surgery.

 

  • Less scarring: There’s no visible scarring because there are no external incisions.

 

  • Lower risk of complications: The precision of endoscopic instruments reduces the risk of damage to nearby structures.

 

Endoscopic surgery is effective for most pituitary tumors, though in some cases, alternative approaches like craniotomy may be necessary, especially for larger tumors or those with a complex location.

 

What can I expect after surgery for a pituitary tumor?

 

After endoscopic pituitary tumor surgery, a short hospital stay is usually required for monitoring. Common post-operative side effects include nasal congestion, headaches and fatigue, which typically resolve within 2 to 4 weeks.

 

Your hospital stay may be longer (about a week) if you have a craniotomy or open surgery. Overall recovery could take up to two months. You may experience post-operative discomfort from the incisions.

 

Regardless of the type of surgery you have, your recovery should involve close follow-up care with the following specialists:

 

  • Endocrinologists: These hormone specialists will monitor your hormone levels, as the surgery may affect your pituitary function. Hormone replacement therapy might be necessary if hormone production is impacted.

 

 

  • Neurosurgeons and otolaryngologists: Your neurosurgeon and ENT will oversee your recovery from the surgical perspective, ensuring proper healing and addressing any complications.

 

 

  • Ophthalmologists: An ophthalmologist will monitor your eye health and recovery if the tumor affected your vision.

 

Regular checkups, including imaging tests and blood work, will help track your recovery progress and detect any potential recurrence of the tumor.

 

Can a pituitary tumor grow back after surgery?

 

While surgery is effective, there’s a chance a pituitary tumor could regrow, especially if any tumor cells remain. That’s why ongoing follow-up care is important. Your healthcare team will regularly monitor your condition to catch any changes early, allowing for prompt intervention, if necessary.

 

The bottom line: If symptoms of a pituitary tumor are affecting your quality of life, surgery may be an option for you. Whether dealing with hormone imbalances or pressure on other brain structures, surgery offers a safe and effective solution for many people. Working with a specialized neurosurgeon and a dedicated medical team, including an ear, nose and throat specialist and endocrinologist, ensures you receive the best possible care tailored to your specific needs.