Pituitary Tumours: Comprehensive Cancer Information

Pituitary Tumours

Pituitary tumours, also known as pituitary adenomas, begin in the pituitary gland. They are almost always benign (non-cancerous), but they can lead to other serious medical conditions.

The problems caused by these tumours can be due to:

  • The overproduction or underproduction of hormones.
  • The tumour growing large enough to press against surrounding areas, such as the optic nerves, which can affect vision.

The pituitary gland, situated at the base of the brain, is about the size of a pea. Despite its small size, it is vital and is often referred to as the "master gland." It is responsible for producing:

  • Growth hormone (GH): Essential for growth in children and metabolism in adults.
  • Prolactin: A hormone important for breast milk production.
  • Other controlling hormones: Hormones that regulate the function of other glands, including the thyroid, adrenal glands, ovaries (in women), and testes (in men).

Types of Pituitary Tumours

Pituitary tumours may be present in up to 15% to 20% of the population, but tumours requiring treatment are less common and are often not diagnosed. The two main types are:

Functioning Tumours

These tumours cause the body to produce an excessive amount of certain hormones. Hormones that may be overproduced include:

  • Prolactin: A tumour that makes too much prolactin is called a prolactinoma. This is the most frequent type of pituitary tumour and stimulates breast growth and milk production in women.
  • Growth hormone (GH): Tumours that overproduce GH cause acromegaly (gradual enlargement of body parts) in adults and gigantism (abnormally large growth) in children.
  • Adrenocorticotropic hormone (ACTH): This hormone signals the adrenal glands to produce cortisol, which manages the body's stress response, blood pressure, and heart function. Excessive ACTH leads to Cushing's disease.
  • Thyroid-stimulating hormone (TSH): Tumours that make too much TSH cause the thyroid to release high levels of thyroxine, resulting in hyperthyroidism (overactive thyroid). This is the most rare type of pituitary tumour.

Non-functioning Tumours

This is the second most frequent type of pituitary tumour and does not produce hormones that cause noticeable symptoms. They can, however, cause problems if they grow large and press against surrounding structures, such as the optic or other nerves. They can also interfere with the pituitary gland's normal hormone production.

Pituitary Cancer (Carcinoma)

In rare instances, the cells within a pituitary tumour can become cancerous and metastasise (spread) to other parts of the body. Most pituitary cancers produce hormones, typically prolactin and ACTH.

Pituitary Tumour Risk Factors

A risk factor is anything that increases your probability of developing a disease. The only proven risk factor for pituitary tumours is inheriting a condition that predisposes you to developing one, such as:

Multiple Endocrine Neoplasia (MEN1)

Family Isolated Pituitary Adenoma (FIPA)

It is important to note that not everyone with MEN1 or FIPA will develop a pituitary tumour. If you or someone in your family has one of these disorders, it is advisable to discuss your risk with your doctor.

Pituitary Tumour Symptoms

Pituitary gland tumours often do not present with symptoms in the early stages, and when they do, they vary widely from person to person. Many patients may live with these tumours for years before they are discovered. Symptoms generally develop slowly and can often resemble those of other medical conditions.

Symptoms may occur if a tumour grows too large and:

  • Presses on normal pituitary tissue: This can disrupt the gland's function, causing a decrease in pituitary hormone levels.
  • Presses on other structures: This can result in headaches, double vision, and loss of vision due to pressure on the optic nerves.

When a pituitary tumour causes other glands to produce too much hormone, the symptoms will depend on the glands involved.

Adrenocorticotropic Hormone (ACTH) - Cushing's Disease

Rounded "moon" face

Weight gain, especially in the trunk and abdomen

Thinning of the skin

Wide purple-red stretch marks

Diabetes

High blood pressure

Muscle weakness

Slowing of growth (in children)

Growth Hormone (GH) - Acromegaly (adults), Gigantism (children)

Hands, feet, jaw, and/or forehead gradually grow larger

Coarse facial features (e.g., thickened skin, enlarged nose or lips)

Heart problems

High blood pressure

Excessive sweating

Thyroid-Stimulating Hormone (TSH) - Hyperthyroidism

Weight loss

Nervousness

Rapid or irregular heartbeat

Prolactin - Prolactinoma

In women:

Milky discharge from the nipples

Irregular or absent menstrual periods

Infertility

In men:

Erectile dysfunction and/or impotence

Infertility

Loss of body hair

Decreased sex drive

Rarely, increased breast growth (gynecomastia)

These symptoms do not automatically mean you have a pituitary tumour, but it is important to discuss any changes with your doctor as they may signal other health issues.

Pituitary Tumour Diagnosis

Diagnosing pituitary tumours can be challenging, especially in the early stages, leading many to remain undiagnosed for years. The blood tests required for diagnosis can be complex and demand specialised expertise. Our expert endocrinologists and neurosurgeons at SSCHRC are highly skilled and experienced in diagnosing pituitary tumours.

If you have symptoms that may suggest a pituitary tumour, your doctor will perform an examination and inquire about your personal and family health history.

One or more of the following diagnostic tests may be used to identify a pituitary tumour, determine its size, and monitor the effectiveness of treatment:

Blood Tests

Urine Tests

Saliva Tests

Specialised Testing

Frequent sampling of blood, saliva, and/or urine

Imaging Tests

  • MRI (Magnetic Resonance Imaging) scans
  • CT or CAT (Computed Axial Tomography) scans

Treatment for Pituitary Tumours

For the best chance of successful treatment, it is important to be under the care of experts who specialise in pituitary tumours and treat a large number of patients. The experienced physicians at SSCHRC customise care plans to provide the most advanced treatments while minimising the impact on your body.

Your specialised medical team may include neurosurgeons, endocrinologists, neuroradiologists, pathologists, neuro-ophthalmologists, and radiation oncologists. The team meets regularly to discuss your care and communicates closely with you to keep you informed of your progress.

The best treatment options will be discussed with your doctor upon diagnosis and depend on several factors, including the tumour's location, size, and the specific hormones it affects. Your treatment will be personalised to your individual needs. One or more of the following therapies may be recommended to treat the tumour or help relieve symptoms:

Surgery

The pituitary tumour may be surgically removed. As with all surgery, pituitary tumour surgery is most successful when performed by a specialist with extensive experience in the procedure. The neurosurgeon's expertise is particularly crucial if surgery is part of your treatment, as the pituitary gland and nearby structures can be vulnerable to damage during the procedure. SSCHRC surgeons are among the most skilled and recognised globally, performing a high volume of pituitary tumour surgeries each year.

Medicine

You may be prescribed one or more medicines to help reduce hormone levels or shrink the pituitary tumour. Hormone replacement therapy may also be administered if your natural hormone levels are low.

Radiation Therapy

SSCHRC offers the most advanced radiation treatments for pituitary tumours. New radiation therapy techniques and exceptional skill enable SSCHRC doctors to target pituitary tumours with greater precision, delivering the maximum necessary radiation with the least damage to surrounding healthy cells.

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