Pituitary Tumor Program

Hypopituitarism is a condition in which the pituitary gland does not secrete enough hormone. It can be result of a pituitary tumor causing compression and damage of the pituitary gland. Other potential causes are pituitary surgery, pituitary radiation therapy, decreased blood flow (in case of stroke or hemorrhage), medications (narcotics, cancer medications called check-point inhibitors), infection, or infiltration by other systemic conditions (such as sarcoidosis, hemochromatosis).

• Symptoms: depends on the type of hormone that is deficient:
  • ACTH/Cortisol: fatigue, weight loss, low blood pressure, nausea, vomiting, abdominal pain, dizziness.
  • TSH/T4 (thyroid hormone): fatigue, weight gain, dry skin, constipation, cold intolerance.
  • LH/FSH (sex hormones): Fatigue, mood changes. Men: decreased libido, decreased erections, decreased body/facial hair. Women: irregular periods/no periods, hot flashes, decreased body/facial hair.
  • Growth hormone: fatigue, weakness, metabolic changes, mood changes, increased body fat.
  • Prolactin: inability to breastfeed.
  • Antidiuretic hormone (vasopressin): increased thirst, increased urination during the day and night.
• Treatment: focuses on replacement of the deficient pituitary hormone.
  • ACTH/Cortisol: hydrocortisone or prednisone
  • TSH/T4 (thyroid hormone): levothyroxine
  • LH/FSH (sex hormones): testosterone for men and estradiol for women
  • Growth hormone: daily or weekly growth hormone
  • Antidiuretic hormone (vasopressin): desmopressin

Craniopharyngioma are benign brain tumors that arise from remnants of embryonic tissue near the pituitary gland.

• Symptoms: vision loss, headaches and symptoms of hormone deficiency.
• Diagnosis: MRI is the best diagnostic modality.  Types: adamantinomatous (more common in children) and papillary (more common in adults).
• Treatment: surgical resection is the first line treatment. Radiation therapy can also be considered as adjuvant therapy. Specific targeted therapy, such as BRAF inhibitors, could be considered in the papillary subtype.

Meningiomas are benign brain tumors that arise from the meninges (membranes that surround the brain) and can be located at the base of the skull causing compression of the pituitary gland.

• Symptoms: vision loss, headaches and symptoms of hormone deficiency.
• Diagnosis: MRI is the best diagnostic modality.
• Treatment: surgical resection is the first line treatment for symptomatic or growing sella meningiomas. Radiation therapy can also be considered as adjuvant therapy.

Rathke’s cleft cyst is a benign fluid-filled sac that originates from remnants of the Rathke’s cleft pouch, an embryonic part that develops into the pituitary gland.

• Symptoms: most of the Rathke’s cleft cyst do not cause any symptoms if it is small. Larger cysts can affect the vision, cause headaches, and lead to symptoms of hormone deficiency.
• Diagnosis: MRI is the best diagnostic modality.
• Treatment: if the Rathke’s cleft cyst is large and is causing compression of nearby structures, surgery by an expert neurosurgeon is the first line of treatment. 

Pituitary adenomas are classified by:

• Size: microadenomas are pituitary adenomas that measure less than 1 cm, macroadenomas are tumors measuring 1 cm or more.
• Functional status: depending on the type of hormone they secrete.
  

• Prolactin-secreting pituitary adenoma: most common type of pituitary adenoma.
  • Symptoms: women experience irregular periods and breast milk production; men experience decreased libido and erectile dysfunction. 
  • Diagnosis: elevated prolactin in blood, decreased sex hormones, MRI
  • Treatment: medical treatment may be sufficient in majority of cases but surgery and/or radiation therapy could be considered in limited cases.
• Growth hormone-secreting pituitary adenoma: causes acromegaly.
  • Symptoms: may result in excessive growth of nose, hands, feet, jaw, hypertension, diabetes.
  • Diagnosis: elevated growth hormone/IGF-1, MRI
  • Treatment: surgical removal of the tumor by an expert neurosurgeon is the first-line therapy. Medical therapy and/or radiation is used if surgery fails to achieve remission.
• ACTH-secreting pituitary adenoma: causes Cushing disease.
  • Symptoms: weight gain, weakness, thinning arms/legs, stretch marks, diabetes, hypertension, osteoporosis.
  • Diagnosis: elevated cortisol in urine, saliva and blood.
  • Treatment: surgical removal of the tumor by an expert neurosurgeon is the first-line therapy. Medical therapy and/or radiation is used if surgery fails to achieve remission.
• Non-functioning pituitary adenoma: do not secrete any hormone in excess, but it can lead to low hormones due to compression of the pituitary gland.

Pituitary adenoma is a benign growth on your pituitary gland that can interfere with your normal pituitary function or can grow and cause pressure on nearby structures. Pituitary adenomas have a prevalence of approximately 10% among the general population and several times are discovered incidentally during a CT or MRI obtained for other purposes. Large pituitary tumors can cause compression of the optic nerves causing vision loss or affect the pituitary function leading to symptoms of low hormone production.