Understanding pituitary tumours

The pituitary is a gland located at the base of the brain and it is responsible for managing the hormones that determine the body’s growth, metabolism, and sexual reproduction. Dysfunction of this gland will take a toll on the body. Sometimes the gland does not work for simple operational reasons, but sometimes it is due to the presence of a tumour. Professor Miles Levy, consultant endocrinologist, goes through the signs and the treatment for tumours in the pituitary gland.

The pea-sized pituitary gland, also known as the “master gland”, prepares the body for change by secreting hormones and maintaining their levels. The pituitary keeps the other glands in order within the complex endocrine system.

What is a pituitary tumour?

Although they might cause worry, tumours in the pituitary gland are not always cancerous. Aside from cancerous tumours, there are benign pituitary tumours called adenomas, of which there are two kinds:

1. Functioning (secreting), which can secrete extra hormones which will have an effect on the body externally or internally
2. Nonfunctioning (non-secreting), which don’t cause an influx of hormones but will put pressure on the brain, eyes or optic nerve. These are the most common.

There is also further categorisation based on sizes: microadenomas, which are smaller than 10 millimetres; and macroadenomas, which are larger than 10 millimetres and are most likely to stunt pituitary hormones in what is called hypopituitarism.

How does a pituitary tumour affect the body?

Due to the pituitary gland’s close proximity to the optic nerve, if it changes in size, this can affect vision in ways such as blurriness, double vision, or loss of peripheral range. Macroadenomas can also trigger headaches and pressure on the brain. Other symptoms when the pressure on the brain increases are drooping facial muscles, nausea, and seizures.

As the pituitary is the master gland, that means it oversees the hormone production of other glands in the body. Pituitary tumours that obstruct normal hormone production will cause hormonal issues such as abnormal menstruation cycles, weight gain and loss, and affected libido.  As the pituitary is also in charge of metabolism, any issues with it can lead to reduced appetite and fatigue. Patients may also experience mood swings and irritability. Tumours tell the gland to either make too many or too few hormones, with both extremes being harmful to the body. Some people who have pituitary gland tumours can experience sudden growth spurts, changes in facial features, and have their limbs, feet, and hands grow extra large.

How pituitary tumours can affect other glands and the symptoms:

• The gonads
  • Hypogonadism, where there is too little of the sex hormones (oestrogen, testosterone, and progesterone) and the body fails to develop the secondary sexual characteristics properly in children, and for adults the body begins to lose hair, irregular breast tissue development, and irregular periods, for example
  • Hypergonadism, where there are too many of the sex hormones, and can look like growing excess body hair, increased sex drive, and acne outbreaks
• The thyroid
  • Hypothyroidism, where the thyroid is not producing enough thyroxine, which will manifest as fatigue, dry skin, swollen limps and sluggishness.
  • Hyperthyroidism, where the thyroid produces too much thyroxine and will look like rapid heart rate, sweating, hand tremors, and unexplained weight loss.
• The adrenal glands
  • Adrenal insufficiency, where there is too little cortisol in the body and this means low blood pressure, nausea and vomiting, abdominal pain and lack of appetite.
  • Cushing’s syndrome, where there is too much cortisol, causing high blood pressure, muscle and bone density weakness, thick purple and red stretchmarks all over, and swelling of the face.

How are pituitary tumours diagnosed?

For patients exhibiting any of the conditions and symptoms above, their doctor should conduct a thorough physical examination, along with further tests of the blood and eyes, and finally, an MRI or CT scan to confirm the presence of an abnormal growth in the head.

How can pituitary tumours be treated?

There are a few treatment options available for pituitary glands, and it will depend on how the patient is affected by the tumour, if it is cancerous, and if it is continuing to grow.

Some medications can shrink tumours and prevent the functioning ones from dysregulating hormones.

A procedure called transsphenoidal surgery can remove a tumour through the nasal passages and sinus cavity with help from an endoscope and other instruments that the surgeon will use to excise the tumour from the surface of the gland. This surgery has a very high success rate and another benefit is that it is minimally invasive and will not leave behind any facial scars. However, those with a macroadenoma may not be suitable for this procedure as it could be too large to be taken out through the nose

Patients with cancerous, large, or stubborn tumours that cannot be treated with medication or surgery will have to undergo radiation therapy with powerful X-rays to halt tumour growth and kill any other mutative or cancerous cells so that another tumour doesn’t form.

If you have concerns about pituitary tumours, or regarding abnormal hormone levels, Professor Miles Levy is available for consultation via his Top Doctors profile.