Treatment of Pituitary Tumors


In most of the cases pituitary tumors function normally without treatment if the tumor isn't causing other problems

March 13, 2018

Treatment of Pituitary Tumors

Most of the time, a functional adenoma makes too much of a single pituitary hormone and the symptoms from these adenomas are based on which hormone they make.

Treatment of Pituitary Tumors:

Treatment options and recommendations depend on several factors, including:

  • The type and classification of the tumor
  • How far it has grown into your brain
  • Possible side effects
  • The patient's preferences
  • The patient's age and overall health

Different treatment option include:

Watchful waiting:

If your tumor is not causing any signs or symptoms this therapy is recommended where you might need regular follow-up tests to determine if your tumor grows. In most of the cases pituitary tumors function normally without treatment if the tumor isn't causing other problems. Treatment would begin only if the tumor started causing symptoms.

Surgery:

It is the most common treatment for a pituitary gland tumor where the tumor and some surrounding healthy tissue are removed during an operation. Surgery is often successful in removing the entire tumor by a neurosurgeon. If the tumor is pressing on the optic nerves or if the tumor is overproducing certain hormones, surgery is required. The success of surgery depends on the tumor type, its location, size and whether the tumor has invaded surrounding tissues. There are two main surgical techniques for treating pituitary tumors. These include:

Endoscopic transnasal transsphenoidal approach:

In this method the tumor can be removed through your nose and sinuses without an external incision. The neurosurgeon goes through the nasal passage and along the septum that separates the 2 nostrils and then enter the sphenoid sinus cavity located deep above the back of the throat to the pituitary gland immediately behind it. Any other part of your brain will not be affected, and there will be no visible scar. But large tumors may be difficult to remove in this method, especially if a tumor has invaded nearby nerves or brain tissue.

Craniotomy or Transcranial approach:

In this method the tumor is removed through the upper part of your skull via an incision in your scalp. This can be done using a microscope or an endoscope, or both, so the neurosurgeon can see the tumor. Large or more complicated tumors are removed using this procedure. Speak with your health care team about possible side effects from the specific surgery before opting for any of these. However, both of these methods are equally safe and effective when done by a skilled surgeon.

Radiation therapy:

Radiation therapy uses  high-energy x-rays or other particles to destroy tumor cells. Mostly it is used after surgery. But if surgery is not an option then it is used alone. Radiation therapy is recommended if a tumor persists or returns after surgery and causes signs and symptoms that does not relieve by medications. Methods of radiation therapy include:

Gamma Knife stereotactic radiosurgery:

In this method a single high dose of radiation beams is focused on the tumor without an incision. Radiation beams of same size and shape of the tumor are focused into the tumor with the aid of special brain-imaging techniques. The healthy tissue surrounding the tumor will come in minimal contact of the radiation given which decreases the risk of damage to normal tissue.

External beam radiation:

In this method radiation in small increments are given in some intervals. Usually five times a week over a four- to six-week period, is performed as a series of treatments. It may take years to fully control the tumor growth and hormone production. Radiation therapy may also damage remaining normal pituitary cells and normal brain tissue, particularly near the pituitary gland.

Proton beam therapy:

Positively charged ions (protons) rather than X-rays are used in this method. Proton beams stop after releasing their energy within their target. The beams can be finely controlled and can be used on tumors with less risk to healthy tissues. The effectiveness of this therapy often are not immediate and may take months or years.

Medications:

To block the secretion of excess hormone and sometimes shrink certain types of pituitary tumors, medication can be used. The drugs cabergoline and bromocriptine decreases prolactin secretion and often help reduce tumor size. Drowsiness, dizziness, nausea, vomiting, diarrhea or constipation, confusion, and depression are the most common side effects of these medication.
Somatostatin analogs (Sandostatin, Somatuline Depot, others) are used to decrease growth hormone production and may shrink the tumor. These are given by injections, usually every 4 weeks. Nausea, vomiting, diarrhea, stomach pain, dizziness, headache and pain at the site of injection are most common side effects of these medication. These medication can also cause gallstones and may worsen diabetes mellitus. Pegvisomant (Somavert) can also be used to block the effect of excess growth hormone on the body. It is given on daily basis by injections and may cause liver damage in some people.

Replacement of pituitary hormones:

HRT is often necessary for people with a pituitary tumor when the gland is not making enough of a hormone due to the disease. You also need pituitary hormone replacement if hormone production is decreased by surgery or radiation treatment. This is given often as a pill, to take regularly. This may include replacement of:

  • Thyroid hormones
  • Adrenal hormones
  • Growth hormone
  • Estrogen in women
  • Testosterone in men