Functional tumors, like pituitary adenomas, produce excess hormones. These hormones may cause a variety of symptoms.
Symptoms include a severe headache and problems with vision. These tumors can also cause a type of stroke called pituitary apoplexy.
These tumors make too much thyroid-stimulating hormone. They can cause weight loss, a fast heartbeat, and sweating.
Symptoms
The pituitary gland controls the production and release of hormones. Some pituitary tumors secrete extra hormones and cause symptoms depending on the type of hormone they release. Healthcare providers classify pituitary tumors based on whether they are functioning (secreting) or nonfunctioning (non-secreting). Nonfunctional adenomas are the most common type of pituitary tumor.
People with a pituitary adenoma may have headaches, vision problems and other symptoms. The exact symptoms depend on the type of adenoma and its location in the brain. The symptoms also depend on whether the adenoma is pressing on nearby structures, such as nerves or the optic chiasm.
A tumor that presses on the chiasm can lead to a condition called visual field loss, which causes one or more parts of your peripheral vision to become dark. It can also cause problems with your depth perception and can cause blurry or doubled vision. Other types of symptoms can include headaches, trouble with balance and changes in your vision.
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If your adenoma is secreting excess prolactin, you might have swollen glands in your hands or feet, large breasts and rapid weight gain. These are signs of Cushing’s disease, which can also cause weakness in the muscles and bones, high blood pressure and flushed skin. A small number of pituitary tumors make too much growth hormone. This can lead to enlarged testicles, deep voice, balding on the temples and facial hair growth in men and precocious puberty in children and women.
Scientists aren’t sure what causes most pituitary adenomas, but they can be hereditary. They also can be caused by accidental changes, or mutations, in the DNA that makes up a cell. Mutations can happen randomly or may be linked to an inherited disorder, such as multiple endocrine neoplasia, type 1 (MEN 1).
Many adenomas are found by chance during tests for other health conditions. Some doctors suspect a pituitary tumor when a person has certain symptoms, such as headache or vision problems. To confirm the diagnosis, healthcare providers do a physical exam and take a history of your symptoms. They also do a magnetic resonance imaging (MRI) scan to see if your pituitary gland has a mass. Other tests can include a blood test to measure your hormone levels and a CT scan to look for other abnormalities in the brain.
Diagnosis
Your health care provider may suspect a pituitary tumor from a physical examination and the symptoms you have. The most accurate way to diagnose a pituitary tumor is through imaging tests, such as magnetic resonance imaging (MRI) and computerized tomography scans (CT). These exams use large magnets, radio waves and a computer to make detailed images of tissues and organs without the use of X-rays.
These tests also can show whether the tumor is pressing on nerves that control your vision (optic nerves). A visual field exam can help your provider see if you have problems with your peripheral, or side, vision. The exam may also check for signs of a hormone imbalance, such as low growth hormone levels (acromegaly) or too much prolactin in men (prolactinoma).
A 24-hour urine test that measures the amounts of certain substances can be used to help determine whether a pituitary tumor is making too many hormones, which can cause Cushing syndrome. Your health care provider will also look at your medical history and ask questions about the symptoms you have.
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When a pituitary tumor is diagnosed, your doctor may prescribe medicine to manage your symptoms and keep the tumor from growing or causing more symptoms. The type of medicine your doctor prescribes will depend on the size and type of your pituitary tumor, whether it is making too many or not enough of a particular hormone, and how your symptoms affect you.
Having a pituitary tumor or having it removed with surgery can change your supply of hormones, which means you might need to take medication for the rest of your life. This is especially true if the tumor caused you to have too little of a certain hormone, such as growth hormone or testosterone. If your pituitary tumor or its removal changes the balance of hormones, your provider will monitor you closely to be sure that your symptoms don’t return. This PDQ cancer information summary was reviewed by the National Cancer Institute (NCI). It is written for patients, families and friends and provides overview information about pituitary tumors.
Treatment
Treatment options may include medication, radiation therapy or surgery. Your doctor will choose the treatment that’s best for you based on your age, general health and how severe your symptoms are.
To diagnose a pituitary tumor, your doctor will review your medical history, do a physical exam and order tests such as bloodwork or imaging studies. These can help your doctor see if the pituitary tumor is putting pressure on other parts of your brain or producing excess hormones. You may also have a visual field test to check how your vision is affected by the tumor. The test uses a series of flashes to examine your peripheral (side) vision. The test may reveal a loss of peripheral vision or it may show that the pituitary tumor is pressing on nerves in the area.
If your pituitary tumor is producing excess hormones, your doctor may prescribe medicines to control the production of these hormones and to shrink the tumor. You may need to take these medicines for the rest of your life.
Some adenomas produce too much prolactin hormone, leading to irregular menstrual periods or problems with milk production in women. Other adenomas produce too much adrenocorticotropic hormone (ACTH), which can lead to Cushing disease in both women and men. Your doctor may recommend a urine test to measure ACTH levels.
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Radiation therapy can treat pituitary tumors by using high-energy X-rays to kill cancer cells in the pituitary. With time, this can lead to tumor shrinkage. It’s usually recommended for smaller tumors. For advanced tumors, doctors may use stereotactic radiosurgery, which delivers radiation to the pituitary in many small, targeted areas. This can reduce the chance of damage to other parts of your brain.
Your doctor may suggest taking part in a clinical trial to study new treatments for pituitary tumors. These trials test whether new treatments are safe and better than standard care. Talk with your doctor about your options if you’re interested. You can find more information about clinical trials from the National Cancer Institute (NCI). It’s important to follow your doctor’s advice during treatment for a pituitary tumor. Eating well, getting enough sleep and reducing stress may help you feel more energized during treatment.
Prevention
There is no way to prevent pituitary tumors. They develop randomly and in most cases, are not related to any other conditions. Some people have a genetic mutation that makes them more likely to get pituitary tumors. These are called familial pituitary adenomas. MedStar Health offers genetic counseling to help you understand your risk and decide whether to undergo screening for pituitary tumors.
Most pituitary tumors do not cause symptoms and are only discovered by chance, usually during an imaging exam (like an MRI or CT scan) done for another reason. Large tumors can affect hormone production, causing problems like headaches or vision changes. They can also put pressure on the normal pituitary gland, which causes other problems, including irregular menstruation and ovarian hyperstimulation syndrome (OHSS) in women and acromegaly in men. Small pituitary tumors that don’t make hormones, called non-functioning microadenomas, usually don’t cause symptoms. These are more common and are usually found during an imaging exam for another reason.
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Non-functional pituitary adenomas can be diagnosed by a brain MRI or CT scan, blood tests and an eye exam to see if the pituitary gland is growing. These tumors are not treated or cured, but they can be monitored and sometimes disappear on their own over time. Other types of pituitary tumors, such as prolactinomas and Cushing’s disease, can be prevented by prompt diagnosis and treatment with medical or surgical therapies.
Surgery to treat a pituitary tumor may damage the pituitary gland and limit its ability to make hormones, especially if it’s in the back of the gland, where the pituitary gland makes the hormone vasopressin. This can lead to a condition called diabetes insipidus, which causes you to produce very large amounts of diluted urine and raises your risk of dehydration. Diabetes insipidus can be treated with medication that increases the level of the hormone vasopressin. You may need regular doses of the medication for life. This is why it’s important to see your healthcare provider regularly.
