Pituitary Tumors – Diagnosis and Treatment

Diagnosis

Pituitary tumors can be hard to notice because many do not cause immediate symptoms. Small tumors that do not produce hormones might stay hidden until a scan for another reason reveals them.

When patients have symptoms, those symptoms often look like other health issues. This overlap can make finding the tumor more challenging. Health care providers begin by reviewing personal and family medical history.

They also perform a physical exam to look for signs of pituitary gland problems. If they suspect a pituitary tumor, they order several kinds of tests.

Common Tests for Pituitary Tumor Detection:

Test Type	Purpose	What It Shows
Blood tests	Measures hormone levels	Too much or too little hormone in the body
Urine tests	Checks for excess hormones such as adrenocorticotropic hormone (ACTH) and cortisol	Signs of hormone-related conditions
MRI scan	Produces detailed brain images	Location and size of the tumor
CT scan	Creates cross-sectional images with X-rays	Detailed images, used for surgery planning
Vision testing	Assesses eyesight, especially peripheral vision	If vision problems may be caused by the tumor

Blood and Urine Tests

Blood tests check for unusual hormone levels. A high hormone result can signal a tumor. Sometimes, doctors diagnose a pituitary adenoma based on these results.

For certain hormones like cortisol, doctors may order more tests to confirm the result and rule out other causes. Urine tests help check for hormone imbalances, especially if ACTH is too high.

High ACTH can cause too much cortisol, which links to Cushing disease.

Imaging Exams

Doctors often choose an MRI scan as the first imaging test. MRI gives clear pictures of the brain and can spot small tumors. It shows exactly where the tumor is and how big it is.

In some cases, doctors order a CT scan to help plan for surgery. MRI is more common, but CT scans can be useful in certain situations.

Vision Evaluation

A pituitary tumor can press on nerves that affect eyesight. Doctors may include eye exams as part of the diagnosis. Many people with pituitary tumors lose some side vision, called peripheral vision.

Vision tests help check for this problem. Doctors may refer patients to an endocrinologist for more tests or to confirm the diagnosis.

This combination of medical history, hormone tests, imaging, and vision exams helps doctors find and understand pituitary tumors.

Treatment

Surgical Removal

Doctors often recommend surgical removal as a first-line treatment for pituitary tumors, especially if the tumor presses on the optic nerves or causes severe symptoms.

Surgery may also be an option if the tumor causes hormone changes or may become problematic over time. The decision to operate depends on tumor size, location, and the symptoms present.

The surgery aims to remove as much of the tumor as possible while protecting healthy brain tissue and the pituitary gland.

Main surgical goals:

• Relieve pressure on nerves and tissues.
• Return hormone levels to normal.

A skilled surgical team is important, often including specialists in brain surgery, sinus surgery, endocrinology, and radiation.

Endoscopic Surgery Through the Nasal Passages

The endoscopic approach through the nasal passages is the most common procedure for removing pituitary tumors.

The surgeon reaches the tumor through the nose and sinuses using a thin tube with a camera. There is no external incision, so this method does not leave visible scars.

This type of surgery is less likely to affect nearby brain areas. Small tumors or those that have not spread beyond the pituitary area are best suited for this approach.

Large or complex tumors might be harder to remove this way, especially if they have grown into nearby nerves or blood vessels.

Advantages:

• No visible scars.
• Less recovery time compared to open surgery.

Possible side effects:

• Temporary headache or nasal congestion.
• Infection or bleeding, though these are rare.

Surgery Through the Skull (Craniotomy)

For larger pituitary tumors or those that extend into the brain or nearby tissues, doctors may recommend removal through the skull, called a craniotomy.

The surgeon makes an opening in the upper part of the scalp and skull to reach the tumor directly. This surgery gives better access for removing tumors that are hard to reach or that have spread.

When to consider this option:

• Tumors invading nearby nerves or brain areas.
• Tumors too large for nasal passage removal.

Risks and complications include:

• Bleeding and infection.
• Reactions to anesthetic.
• Vision changes, headache, or rarely, brain injury.

Managing Diabetes Insipidus After Surgery

Sometimes surgery on the pituitary gland disrupts its ability to produce certain hormones, leading to a condition called diabetes insipidus.

This happens when the body does not have enough vasopressin, the hormone that controls water balance.

Symptoms may include:

• Excessive urination.
• Extreme thirst.

For most people, these symptoms are temporary and go away in a few days. Doctors may prescribe a synthetic version of the missing hormone if symptoms last longer.

Radiation-Based Treatments

Radiation therapy uses focused energy to shrink or control pituitary tumors. Doctors often recommend it when surgery does not remove all of the tumor, if a tumor grows back, or if medications are not effective.

Types of radiation therapies:

Type	Description	Used When
Stereotactic Radiosurgery	Delivers precise high-dose beams in a single session, using imaging for accuracy.	Small localized tumors
External Beam Radiation	Spread out in daily sessions over several weeks, targeting a broad area.	Larger or less defined tumors
Intensity Modulated RT	Uses computers to shape beams closely around the tumor with different strengths.	Irregular-shaped tumors, minimizing healthy tissue
Proton Beam Therapy	Uses proton energy that stops at the tumor to reduce harm to normal brain tissue.	Special cases, limited by equipment availability

Potential side effects:

• Decreased pituitary function.
• Damage to surrounding nerves or tissue.
• Vision changes.

Doctors provide follow-up care after radiation to check hormone levels and monitor for delayed complications.

Medicine for Treatment

Several medicines can help manage symptoms or treat pituitary tumors, especially when the tumor makes too much of a certain hormone.

Medicines may shrink the tumor, stop it from making excess hormones, or help restore normal levels. Doctors choose the type of medicine based on the specific hormone the tumor produces.

Benefits of medication:

• Non-surgical option.
• Can be used alone or with other treatments.

Treating Tumors That Cause High Prolactin

Pituitary tumors that cause high prolactin levels (prolactinomas) often respond well to medicine.

Common drugs for prolactinomas:

• Dopamine agonists are often the first line of treatment for prolactin-secreting tumors.

How they help:

• Lower prolactin hormone production.
• Reduce headaches and restore normal periods in women.

Doctors recommend regular check-ups to monitor progress.

Treatment of Tumors That Increase Adrenocorticotropic Hormone

Some pituitary adenomas cause too much adrenocorticotropic hormone (ACTH), leading to Cushing’s disease.

Doctors manage this with medicines that suppress hormone production, surgery to remove the tumor, or radiation if other treatments are not effective.

Common medicine options:

• Cortisol synthesis inhibitors, which help reduce the amount of cortisol the body produces.

Doctors individualize the plan based on hormone levels, tumor size, and response to treatments.

Care for Growth Hormone-Producing Tumors

Pituitary tumors that produce excessive growth hormone can cause acromegaly in adults and abnormal growth in children.

Doctors often attempt surgery first to remove the tumor. If the entire tumor cannot be removed or surgery isn’t an option, medications may be used.

Medications include:

• Somatostatin analogs to reduce growth hormone production.
• Growth hormone receptor blockers to prevent hormone effects in the body.

The goal is to restore hormonal balance and relieve symptoms such as joint pain and abnormal tissue growth.

Hormone Replacement After Pituitary Tumor Treatment

Surgery or radiation can sometimes lower the pituitary gland’s ability to make hormones.

Doctors use hormone replacement therapy to restore normal hormone levels and prevent problems from low hormone production.

Common replacement hormones:

• Thyroid hormone (for energy and metabolism).
• Cortisol (to manage stress and blood pressure).
• Sex hormones (testosterone or estrogen).
• Growth hormone (mostly used in children or rare adult cases).
• Vasopressin, if diabetes insipidus develops.

Doctors check hormone levels with blood tests and adjust medications as needed. Some people need replacements for a short time, while others may need long-term or lifelong therapy.

Careful Observation Without Immediate Treatment

Sometimes, especially with small tumors that do not cause symptoms, doctors use a wait-and-see approach. They recommend regular check-ups, lab tests, and imaging scans to track tumor size and hormone levels.

Watchful waiting may be recommended when:

• The tumor is small and stable.
• No changes in vision or hormone levels are noted.

If the tumor changes or symptoms develop, doctors may start treatment.

Coping and support

Dealing with a pituitary tumor often brings questions and stress. Learning about the condition helps people know what to expect and can give them a sense of control.

Talking with others who face similar health challenges can be helpful. Many hospitals and clinics connect patients with support groups.

These groups allow people to share experiences and advice in a safe setting.

Tips for Support:

• Ask doctors or nurses about local resources.
• Join online groups for those with pituitary tumors.
• Bring a friend or family member to appointments.

Open communication with the care team and others can make coping easier.

Getting Ready for Your Visit

Steps You Can Take Beforehand

Being prepared can help your appointment go smoothly and ensure you get helpful information.

Create a checklist of:

• Symptoms: List every symptom, even if it doesn’t seem related.
• Major Life Events or Stress: Write down any recent changes or stresses.
• Family Health History: Note conditions that run in your family.
• Medications: Include all prescription drugs, over-the-counter medicines, vitamins, or supplements, with their doses.
• Questions: Prepare questions to ask the doctor.

Sample questions include:

Possible Question	Why It Matters
What may be causing my symptoms?	To understand the root issue
Which tests will I need?	To know what to expect next
Are there alternative actions?	To explore all treatment options
What sort of specialists should I see?	To get the right care team
What restrictions should I follow?	To manage health safely

It often helps to bring someone with you. A friend or family member can help remember what the doctor says and give support.

Tip: Ask if you need to do anything before the visit, like fasting for a blood test.

Questions the Doctor May Ask You

Doctors often start by asking about your symptoms and medical history.

You can expect questions such as:

• When did the symptoms start?
• Are the symptoms steady or do they come and go?

They may also ask:

• How bad are the symptoms?
• What makes the symptoms better or worse?

Doctors might want to know if you have had any past scans or head imaging.

If you prepare answers to these questions, you can help the doctor understand your case more quickly. Be sure to give full and honest details.