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Pituitary Adenoma
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Pituitary Adenoma

(Pituitary Tumor; Nervous System Tumor)

Pronounced: Pi-TU-eh-tar-E ad-eh-NO-muh

En Español (Spanish Version)

Definition

The pituitary, the master gland, is a small organ located at the base of the brain that makes hormones that regulate growth and the activity of most other endocrine glands in the body. A pituitary adenoma is an abnormal growth, or tumor, in the pituitary gland. Pituitary adenomas are benign (not cancerous), and do not spread to other parts of the body. Pituitary adenomas can lead to disturbance of vision and growth, and changes in hormonal balance.

Pituitary Gland

Nucleus factsheet image

© 2008 Nucleus Medical Art, Inc.

Causes

The cause of pituitary adenoma is unknown. Some pituitary tumors, however, have been associated with mutations in DNA (the genetic material that instructs cells what to do). These mutations can be inherited, occur as a result of exposure to cancer-causing substances, or may occur for no apparent reason.

Risk Factors

A family or personal history of multiple endocrine neoplasia, type 1 (MEN1)—a hereditary condition that increases the risk of developing pituitary, hypothalamus, and parathyroid tumors—increases your chances of developing a pituitary adenoma. If you have this condition, be sure to tell your doctor.

Symptoms

Symptoms of pituitary adenomas can vary considerably, largely depending on whether or not the tumor is secreting one or more of a variety of hormones (prolactin, thyrotopin, corticotrophin, growth hormone). Even if the tumor is not producing any hormones, its location at the base of the brain can cause significant symptoms.

General symptoms may include:

  • Headache
  • Blurred vision
  • Impotence and infertility
  • Painful intercourse

Symptoms from Prolactin Secreting Adenoma (40% of all cases)

  • Fractures from osteoporosis
  • Milk production from nonlactating females
  • Amenorrhea
  • Vaginal dryness

Symptoms from Thyrotropin-secreting Adenoma

  • Enlarged thyroid (eg goiter)

Symptoms from Corticotropin-secreting Adenoma:

  • Menstrual disturbance
  • High blood pressure
  • High fasting glucose
  • Skin changes (increased facial hair, acne, bruising, bluish stretch marks
  • Buffalo hump (increased fatty tissue in back)
  • Obesity especially around the wrist
  • Round face

Growth Hormone-secreting Adenoma

  • Acromegaly (adult)
  • Gigantism (child)
  • High blood pressure
  • High fasting blood sugar
  • Facial features coarse
  • Oily skin
  • Excess sweating

Of course, these symptoms may be caused by other, less serious health problems and do not necessarily indicate the existence of a pituitary adenoma.

Pituitary adenomas may also be associated with the following conditions:

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. You may be referred to an endocrinologist, a doctor who specializes in diseases of the endocrine glands and their hormones. Tests may include:

  • Blood tests—to measure hormone levels, blood sugar levels (prolactin, TSH, growth hormone, corticotrophin or aCTH, beta human gonadotropin, nsulin-like growth factor-1, alpha subunit), and to identify other underlying conditions that may be causing your symptoms
  • Urine tests—to measure excretion levels of certain pituitary gland hormones (beta human gonadotropin, cortisol)
  • Visual field tests—to check for problems with peripheral vision
  • MRI scan—a test that uses strong magnets and radio waves to create pictures of structures inside the brain

Special Tests

  • Glucose tolerance test—the standard test for acromegaly
  • Dexamethasone suppression test and corticotropin-releasing hormone (CRH) test—best tests to see if excessive secretion of hormones from the adrenal gland is due to a pituitary adenoma.

Treatment

Treatment for a pituitary adenoma depends on the presence and identification of hormones being secreted. It is not uncommon for these treatment options to be used in combination. Talk with your doctor about the best treatment plan for you.

Treatment options include:

Surgery

The most common treatment for a pituitary adenoma is surgery to remove the tumor (eg, trans-sphenoidal adenomatomy). If the pituitary gland is damaged during surgery, it can be treated with medications to replace certain hormones produced by the pituitary.

Medications

Medications that block hormone secretion can control symptoms and sometimes shrink the tumor. These include: dopamine agnoists 9eg bromocriptine) and octreotide.

Radiation Therapy

Radiation therapy involves the use of radiation to kill tumor cells. The types of radiation therapy used to treat pituitary adenomas include:

  • Conventional therapy—radiation is directed at the pituitary from a source outside the body
  • Stereotactic radiosurgery—an intense radiation beam is targeted directly at the tumor
  • Proton beam radiotherapy—a beam of protons (positively charged particles) is directly focused on the tumor

Prevention

There are no guidelines for preventing a pituitary adenoma.

RESOURCES:

American Cancer Society
http://www.cancer.org

Hormone Foundation
http://www.hormone.org

Pituitary Network Association
http://www.pituitary.org

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca

Canadian Health Network
http://www.canadian-health-network.ca

References:

Becker A, Daly AF: The clinical, pathological, and genetic features of familial isolated pituitary adenomas. Eur J Endocrinol 2007;57:371-82.

Beshay VE, Beshay JE, Halvorson LM: Pituitary tumors: diagnosis, management, and implications for reproduction. Semin Reprod Med 2007;25:388-401.

Detailed guide: pituitary tumor. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=61 . Accessed November 8, 2005.

Pituitary tumors information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/pituitary_tumors/pituitary_tumors.htm . Accessed November 8, 2005.

Pituitary tumors (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/pituitary/patient . Accessed November 8, 2005.



Last reviewed January 2008 by David Juan, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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