Pituitary Tumors

Diagnosis

Depending on the type of tumor the patient have and whether it cause symptoms or not, the diagnostic procedure for pituitary adenomas will vary, and due to the symptoms similarity to those of other illnesses, pituitary tumors often go undetected.

Sometimes, medical examinations for other illnesses lead to the discovery of pituitary tumors.

Specialist will perform a physical examination as well as gather the medical history to determine whether the patient has a pituitary tumor. The specialist may recommend the following test:

• Blood tests: Pituitary tumor can be diagnosed using blood tests that measure the levels of hormonal abnormalities associated with pituitary tumors.
• Urine tests: used to identify breakdown products of hormone processing in your body 
• Imaging tests: To determine the location and size of the tumor, the specialist may recommend imaging tests of the brain. Imaging test includes.
  • Magnetic Resonance Imaging (MRI) scan that creates a thorough, 3-D image of the brain and surrounding tissue using a magnet and radio waves.
  • Computerized tomography (CT) with series of images are captured. The specialist can assess how the pituitary tumor may be affecting patients by creating a thorough view of it using the photographs on a computer.
• Vision testing: To check if the sight or peripheral vision of the patient has been affected by pituitary tumor.

Treatment

Treatment is not necessary for most pituitary tumors. If the patient has a tumor, the type, size, and depth to which it has spread will determine the treatment. The age and general health are additional considerations.

A multidisciplinary approach will be recommended, which involves specialist from different field, ENT surgeon, neurosurgeon, endocrinologist, and oncologist (radiation). To remove a pituitary tumor and restore normal hormone production, doctors typically utilize surgery, radiation therapy, and drugs, either individually or in combination.

Medications

Medication may assist to reduce various forms of pituitary tumors and stop excessive hormone secretion:

• Prolactin-secreting tumors (prolactinomas): This drug decreases prolactin secretion and reduces the size of the tumor. The use of cabergoline and bromocriptine will be closely monitored. Possible side effects of these drug includes dizziness, nausea, drowsiness, diarrhea, constipation, and depression.
• ACTH-producing tumors (Cushing syndrome): This drug reduces the adrenal gland’s excessive cortisol production. The use of ketoconazole, mitotane and metyrapone will be closely monitored. Osilodrostat also decreases the production of cortisol. Pasireotide reduces the amount of ACTH produced by a pituitary tumor. Possible sign effect of these drug include nausea, diarrhea, high blood pressure, and weakness.
• Growth hormone-secreting tumors: These kinds of pituitary tumors can be treated with two different types of medications, which are especially helpful if surgery hasn’t been able to restore normal growth hormone production. Somatostatin analogs like octreotide and lanreotide reduce the synthesis of growth hormone, which may cause the tumor to shrink. The second class of medication, pegvisomant, prevents the body from being affected by too much growth hormone. Possible side effect of these drug include nausea, vomiting, headache, and stomach pain.

Radiation therapy

Tumors are eliminated by radiation therapy using high-energy radiation. If surgery is not a possibility, radiation can be done alone. If a tumor remains after surgery or recurs and creates signs and symptoms that drugs are unable to treat, radiation therapy may be helpful. Among the radiation therapy techniques are:

• Stereotactic radiosurgery: radiation beams are focused on the tumor without making an incision and are frequently administered as a single high dose. The risk of damaging normal tissue is reduced since little radiation interacts with the healthy tissue surrounding the tumor. With the use of specialized brain imaging tools, radiation beams are delivered directly onto the tumor.
• External beam radiation: This gradually releases radiation in little doses which takes a long time to stop the tumor growth. Radiation therapy has the potential to harm healthy brain tissue and any remaining normal pituitary cells, especially in areas close to the pituitary gland.
• Intensity modulated radiation therapy (IMRT): With the use of a computer, the physician can utilize this form of radiation therapy to shape the beams and surround the tumor from a different angle. Additionally, the beams’ intensity can be controlled, which will reduce the amount of radiation that reaches nearby tissues.
• Proton beam therapy: This type of radiation uses positively charged ions (protons). Proton beams release their energy inside onto the tumor. The beams can be precisely regulated and can be applied to tumors with little harm to healthy tissues.

Surgery

Pituitary tumors that are pressing on the optic nerves or that are overproducing hormones, will be surgically removed. The type of tumor, its location, size, and if it has spread to surrounding tissues all determine the outcome of the surgery. Pituitary tumors can be treated surgically using two main methods:

• Endoscopic transnasal transsphenoidal approach: This will allow the surgeon to remove the tumor without making an external incision by going through the nose and sinus. The brain will be unaffected, and no scar will be visible. This procedure may difficult to remove large tumors, especially if the tumor has spread to surrounding nerves or brain tissue.
• Transcranial approach (craniotomy): A scalp incision is used to remove the tumor from the upper part of your skull. This approach makes it simpler to access larger or more difficult tumors.

Replacement of pituitary hormones

To maintain normal hormone levels, patient need to take replacement hormones if a pituitary tumor is found or surgery to remove it that reduces hormone production. Replacement pituitary hormones are necessary for some radiation patients.

Observation

If the patient decides to observe for a certain period of time prior to treatment, routine follow-up examination to see if the tumor has grown will be required. If the tumor isn’t causing any symptoms or signs, this can be a choice of treatment.

If the pituitary tumor isn’t creating additional issues, many patients manage without treatment. For younger patients, observation is recommended but the patient must understand that the tumor could change or develop while being observed. Patient could discuss with the specialist for possible symptoms and potential treatment.