Pituitary Adenoma (Pituitary Tumor, Nervous System Tumor)

SymptomsSymptoms of pituitary adenomas can vary considerably, largely depending on whether or not the tumor is secreting one or more of a variety of hormones (prolactin, thyrotopin, corticotrophin, growth hormone). Even if the tumor is not producing any hormones, its location at the base of the brain can cause significant symptoms. General symptoms may include: HeadacheBlurred visionImpotence and infertilityPainful intercourseSymptoms from Prolactin Secreting Adenoma (40% of all cases)Fractures from osteoporosisMilk production from nonlactating femalesAmenorrheaVaginal drynessSymptoms from Thyrotropin-secreting AdenomaEnlarged thyroid (eg goiter)Symptoms from Corticotropin-secreting Adenoma:Menstrual disturbanceHigh blood pressureHigh fasting glucoseSkin changes (increased facial hair, acne, bruising, bluish stretch marksBuffalo hump (increased fatty tissue in back)Obesity especially around the wristRound faceGrowth Hormone-secreting AdenomaAcromegaly (adult)Gigantism (child)High blood pressureHigh fasting blood sugarFacial features coarseOily skinExcess sweatingOf course, these symptoms may be caused by other, less serious health problems and do not necessarily indicate the existence of a pituitary adenoma. Pituitary adenomas may also be associated with the following conditions:

Diabetes mellitusKidney stonesCardiovascular diseaseHigh blood pressureOsteoporosisThyroid disease Diagnosis Your doctor will ask about your symptoms and medical history, and perform a physical exam. You may be referred to an endocrinologist, a doctor who specializes in diseases of the endocrine glands and their hormones. Tests may include: Blood teststo measure hormone levels, blood sugar levels (prolactin, TSH, growth hormone, corticotrophin or aCTH, beta human gonadotropin, nsulin-like growth factor-1, alpha subunit), and to identify other underlying conditions that may be causing your symptomsUrine teststo measure excretion levels of certain pituitary gland hormones (beta human gonadotropin, cortisol)Visual field teststo check for problems with peripheral visionMRI scan a test that uses strong magnets and radio waves to create pictures of structures inside the brain Special TestsGlucose tolerance testthe standard test for acromegalyDexamethasone suppression test and corticotropin-releasing hormone (CRH) testbest tests to see if excessive secretion of hormones from the adrenal gland is due to a pituitary adenoma. TreatmentTreatment for a pituitary adenoma depends on the presence and identification of hormones being secreted. It is not uncommon for these treatment options to be used in combination. Talk with your doctor about the best treatment plan for you.

Treatment options include: SurgeryThe most common treatment for a pituitary adenoma is surgery to remove the tumor (eg, trans-sphenoidal adenomatomy). If the pituitary gland is damaged during surgery, it can be treated with medications to replace certain hormones produced by the pituitary. MedicationsMedications that block hormone secretion can control symptoms and sometimes shrink the tumor. These include: dopamine agnoists 9eg bromocriptine) and octreotide. Radiation Therapy Radiation therapy involves the use of radiation to kill tumor cells. The types of radiation therapy used to treat pituitary adenomas include: Conventional therapyradiation is directed at the pituitary from a source outside the bodyStereotactic radiosurgeryan intense radiation beam is targeted directly at the tumorProton beam radiotherapya beam of protons (positively charged particles) is directly focused on the tumor PreventionThere are no guidelines for preventing a pituitary adenoma. RESOURCES: American Cancer Societyhttp://www.cancer.org Hormone Foundationhttp://www.hormone.org Pituitary Network Associationhttp://www.pituitary.org CANADIAN RESOURCES: Canadian Cancer Societyhttp://www.cancer.ca Canadian Health Networkhttp://www.canadian-health-network.ca

References: Becker A, Daly AF: The clinical, pathological, and genetic features of familial isolated pituitary adenomas. Eur J Endocrinol 2007;57:371-82. Beshay VE, Beshay JE, Halvorson LM: Pituitary tumors: diagnosis, management, and implications for reproduction. Semin Reprod Med 2007;25:388-401. Detailed guide: pituitary tumor. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=61 . Accessed November 8, 2005. Pituitary tumors information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/pituitary_tumors/pituitary_tumors.htm . Accessed November 8, 2005. Pituitary tumors (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/pituitary/patient . Accessed November 8, 2005. Last reviewed January 2008 by David Juan, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.