Pituitary Tumors

Pituitary Tumors

 

Definition

Pituitary tumors are abnormal growths on the pituitary gland. Some tumors secrete hormones normally made by the pituitary gland.

Description

Located in the center of the brain, the pituitary gland manufactures and secretes hormones that regulate growth, sexual development and functioning, and the fluid balance of the body. About 10% of all cancers in the skull are pituitary tumors. Pituitary adenomas (adenomas are tumors that grow from gland tissues) and pituitary tumors in children and adolescencents (craniopharyngiomas) are the most common types of pituitary tumors. They are usually benign and grow slowly. Even malignant pituitary tumors rarely spread to other parts of the body.
Pituitary adenomas do not secrete hormones but are likely to be larger and more invasive than tumors that do. Craniopharyngiomas are benign tumors that are extremely difficult to remove. Radiation does not stop them from spreading throughout the pituitary gland. Craniopharyngiomas account for less than 5% of all brain tumors. Pituitary tumors usually develop between the ages of 30 and 40, but half of all craniopharyngiomas occur in children, with symptoms most often appearing between the ages of five and ten.

Causes and symptoms

The cause of pituitary tumors is not known, but may be genetic. Symptoms related to tumor location, size, and pressure on neighboring structures include:
  • persistent headache on one or both sides, or in the center of the forehead
  • blurred or double vision; loss of peripheral vision
  • drooping eyelid caused by pressure on nerves leading to the eye
  • seizures
Symptoms related to hormonal imbalance include:
  • excessive sweating
  • loss of appetite
  • loss of interest in sex
  • inability to tolerate cold temperatures
  • nausea
  • high levels of sodium in the blood
  • menstrual problems
  • excessive thirst
  • frequent urination
  • dry skin
  • constipation
  • premature or delayed puberty
  • delayed growth in children
  • galactorrea (milk secretion in the absence of pregnancy or breast feeding)
  • low blood pressure
  • low blood sugar

Diagnosis

As many as 40% of all pituitary tumors do not release excessive quantities of hormones into the blood. Known as clinically nonfunctioning, these tumors are difficult to distinguish from tumors that produce similar symptoms. They may grow to be quite large before they are diagnosed.
Endocrinologists and neuroendocrinologists base the diagnosis of pituitary tumors on:
  • the patient's own observations and medical history
  • physical examination
  • laboratory studies of the patient's blood and cerebrospinal fluid
  • x rays of the skull and other studies that provide images of the inside of the brain (CT, MRI)
  • vision tests
  • urinalysis

Treatment

Some pituitary tumors stabilize without treatment, but a neurosurgeon will operate at once to remove the tumor (adenectomy) or pituitary gland (hypophysectomy) of a patient whose vision is deteriorating rapidly. Patients who have pituitary apoplexy may experience very severe headaches, have symptoms of stiff neck, and sensitivity to light. This condition is considered an emergency. Magnetic resonance imaging (MRI) is the best imaging technique for patients with these symptoms. If the tumor is small, surgery may be done through the nose. If the tumor is large, it may require opening the skull for tumor removal. Selected patients do well with proton beam radiosurgery (the use of high energy particles in the form of a high energy beam to destroy an overactive gland).
Treatment is determined by the type of tumor and by whether it has invaded tissues adjacent to the pituitary gland. Hormone-secreting tumors can be successfully treated with surgery, radiation, bromocriptine (Parlodel), Sandostatin (Octreotide), or other somatostatin analogues (drugs similar to somatostatin). Surgery is usually used to remove all or part of a tumor within the gland or the area surrounding it, and may be combined with radiation therapy to treat tumors that extend beyond the pituitary gland. Removal of the pituitary gland requires life-long hormone replacement therapy.
Radiation therapy can provide long-term control of the disease if it recurs after surgery, and radioactive pellets can be implanted in the brain to treat craniopharyngiomas. CV205-502, a new dopamine agonist (a drug that increases the effect of another, in this instance dopamine) can control symptoms of patients who do not respond to bromocriptine.

Prognosis

Pituitary tumors are usually curable. Following surgery, adults may gradually resume their normal activities, and children may return to school when the effects of the operation have diminished, and appetite and sense of well-being have returned. Patients should wear medical identification tags identifying their condition and the hormonal replacement medicines they take.

Resources

Organizations

American Brain Tumor Association. 2770 River Road, Des Plaines, IL 60018. (800) 886-2289. 〈http://www.abta.org〉.
Brain Tumor Information Services. Box 405, Room J341, University of Chicago Hospitals, 5841 S. Maryland Ave., Chicago, IL 60637. (312) 684-1400.

Key terms

Agonist — A drug that increases the effectiveness of another drug.
Analogue — A drug that is similar to the drug from which it is derived.
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Her expertise is in caring for patients with cranial base disorders, including extensive experience with pituitary tumors, meningiomas, acoustic neuromas and head and neck malignancies.
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Non-functional pituitary adenomas, of which 80% are gonadotropin-secreting adenomas, were reported to account for between 15% and 45% of all pituitary tumors.
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2) Incidence rate of acromegaly with GH over secretion is up to 15% in MEN-1 pituitary tumors similar to non-MEN-1 pituitary tumors.
It is clear that thorough evaluation of histology and immunohistochemistry provides the basis for a classification of pituitary tumors that correlates with clinical findings, imaging, surgical findings, and responses to therapies.
Papers touch on areas such as molecular pathology of head and neck cancer, the pathogenesis of pituitary tumors, molecular genetics of acute lymphoblastic leukemia, and microRNAs in cancer.
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31,32) The primary treatment of pituitary tumors is resection and long-term monitoring for disease recurrence and metastatic disease.