The pituitary is a small gland in the brain behind the back of the nose. It makes hormones that affect many glands and functions in your body.
A pituitary tumor is an abnormal growth in the pituitary gland. Most pituitary tumors are not cancer and they do not spread. They can cause the pituitary gland to make too few or too many hormones.
Pituitary tumors may cause your body to make too many hormones, which cause symptoms related to each hormone. Pituitary tumors often press against the nearby optic nerves in your eyes, causing vision problems.
Types of Pituitary Tumors:
Nonfunctional adenomas (null cell adenomas)
These tumors begin in brain cells called astrocytes. Astrocytes help keep nerve cells healthy. Astrocytomas are the most common childhood brain cancer. Types of astrocytic tumors include brain stem glioma, pineal astrocytic tumors, pilocytic astrocytoma, diffuse astrocytoma and anaplastic astrocytoma.
Prolactin-producing tumors (prolactinomas)
These are benign (non-cancerous) tumors that make too much prolactin – a hormone that can make a woman's menstrual period very irregular. Too much prolactin also can stop a woman's menstrual cycle and periods. These tumors can cause women's bodies to produce breastmilk, even when not pregnant, or nursing. Men might experience erectile dysfunction from too much prolactin or may lose interest in sex. Enlarged breasts, low sperm count, less body hair, and headaches and vision problems over time can occur.
ACTH-producing tumors
ACTH (adrenocorticotropic hormone) is a hormone that stimulates our adrenal glands to produce steroids called glucocorticoids. Glucocorticoids affect our metabolism. Glucocorticoids can reduce inflammation on our bodies. If the body has too much ACTH, it can cause Cushing's disease. This disease causes fat buildup in the neck, face, belly, chest, and back. The legs and arms can become thinner. High blood pressure or purple-colored stretch marks occur, and bones might weaken.
Growth hormone-producing tumors
Too much growth hormone can stimulate many bones in children's bodies to grow out of proportion. Gigantism is the name for this syndrome. Gigantism can cause increased height (over 7 feet), growing too fast, joint pain, and heavy sweating. Too much growth hormone in adults causes a growth condition called acromegaly.
Tests
During the diagnostic stage, we will discover where the tumor is, how big, its spread if any, and details including if the tumor is benign, malignant, a primary or secondary tumor.
- Benign tumors are non-cancerous, but they can grow and press on nearby areas of the brain or spine. They may severely impair brain or spinal cord function. They rarely spread into other tissues, but they can recur (come back).
- Primary tumors are those that started in the brain or spine. Primary tumors may spread to other parts of the brain or spine. They rarely spread to other parts of the body.
- Secondary, or metastatic tumors started somewhere else in the body, then spread to the brain or spine. These tumors are more common than primary brain tumors.
Neurological Exam
Questions and tests to check the brain, spinal cord, and nerve function are called a neurological exam, neuro exam, or neurologic exam. Your mental status, coordination, ability to walk, reflexes, and muscles are measured.
Visual Field Exam
Surgery is the most common treatment for pituitary gland tumors. About 95 percent of surgeries to remove pituitary gland tumors are done by the transsphenoidal route, through the nasal passages and sinus cavity. This surgery is called a craniotomy. Craniotomy procedures can be done using a microscope or an endoscope.
Tumor Marker Test
Tissue, blood, and urine samples are reviewed for substances related to various cancers. These are called tumor markers.
Gene Testing
A sample of blood or tissue gets viewed in a laboratory. Our experts look for any changes in chromosomes linked to certain brain tumors. We can also diagnose an inherited syndrome.
Computed Tomography (CT or CAT scan)
This procedure makes a series of detailed pictures of areas inside the body from different angles. A colored dye may be injected into a vein or given as a liquid. The dye makes tissue or organ abnormalities show up clearly. Computed tomography, computerized axial tomography, and computerized tomography are other names for this test.
Magnetic Resonance Imaging (MRI)
This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells, so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). MRI is often used to diagnose tumors in the spinal cord. Sometimes a procedure called magnetic resonance spectroscopy (MRS) is done during the MRI scan. An MRS is used to diagnose tumors, based on their chemical make-up.
Single Photon Emission Computed Tomography (SPECT) Scan
In this diagnostic test, a special camera is linked to a computer to make a 3-dimensional picture of the brain. Safe amounts of a radioactive substance are injected with a needle or given through the nose and inhaled. The camera rotates around the head. Pictures show us where blood or bodily fluids are flowing abnormally. Cancer cells can be the cause of this, and we identify those locations.
Positron Emission Tomography (PET) Scan
You will lie down on the PET scan machine, as the PET scanner rotates around your body. Tiny amounts of radioactive sugar (glucose) are injected into a vein. The PET scanner makes pictures of where cells in your brain are using the glucose as energy more than in other areas. These are likely cancer cells because they are more active than healthy cells.
Biopsies
Biopsies help determine if a pituitary cancer tumor is cancerous. Biopsies are performed with imaging help from an ultrasound, CT or MRI. A pathologist checks the biopsy sample to find out the tumor type and grade (how quickly the tumor may grow or spread).
- Stereotactic Biopsy: This test looks at tumors deep in the brain. We use a computer and 3-dimensional 3-D scanning device. The image allows us to guide the needle used to remove the tissue. A small incision made in the scalp allows the surgeon to insert the biopsy needle to remove cells or tissues. The cells and tissue are viewed under a microscope by a pathologist.
Treatments
Active Surveillance
If you have no symptoms from the tumor and your hormones are working properly, we may not treat you immediately. Active surveillance is the name of this approach. It is sometimes called watchful waiting. Your health will be monitored at regular examinations. We will look for any signs of tumor growth or progression. Treatment would begin if the tumor started causing symptoms.
Surgery
Surgery is the most common treatment for pituitary gland tumors. About 95 percent of surgeries to remove pituitary gland tumors are done by the transsphenoidal route, through the nasal passages and sinus cavity. This surgery is called a craniotomy. Craniotomy procedures can be done using a microscope or an endoscope.
Radiation Therapy
Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells.
- External-Beam Radiation Therapy: Radiation delivered by a machine outside the body is external-beam radiation therapy. Your treatment plan will be on a regimen schedule. It usually includes a specific number of treatments given over a set period. Improvements in technology allow us to aim the radiation directly at the pituitary gland. This accuracy ensures less potential damage to surrounding healthy tissue.
- Stereotactic Body Radiation Therapy (SBRT): Therapy that aims a single large dose of radiation directly at a brain tumor. Stereotactic radiosurgery or radiosurgery are other names for this therapy, but it is not technically a surgical procedure.
Hormone Replacement Therapy (HRT)
HRT is often necessary for patients with a pituitary tumor when the gland is not making enough of a hormone due to the disease. This may include replacement of thyroid hormones, adrenal hormones, growth hormone, testosterone in men, and estrogen in women.
Chemotherapy
Pituitary tumors that overproduce hormones can be treated with chemotherapy. Bromocriptine (Parlodel) and cabergoline (Dostinex) are drugs that treat tumors that secrete prolactin. Octreotide (Sandostatin) and pegvisomant (Somavert) treat tumors that make growth hormone. Octreotide can treat pituitary tumors that secrete thyroid-stimulating hormone.
Supportive and Palliative Care
Supportive care and pain management services are available to help relieve symptoms and reduce side effects. Palliative treatments can include medication, nutritional changes, relaxation techniques, emotional support, and other therapies.
Why Choose Sylvester Comprehensive Cancer Center?
Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.
Intrathecal chemotherapy for appropriate brain and neurological cancer patients. This advanced treatment provides greater accuracy and safety than traditional chemotherapy for select tumors. We deliver medicine directly into the tumor site through a dissolving wafer.
Targeted therapies available in addition to traditional treatments. Our experts offer more options than others to eliminate your cancer and stop it from coming back.
Leaders in gene therapy research. You’ll be cared for by a team including experts in the world’s newest molecular and genetic treatments.
Multidisciplinary care teams with nationally recognized expertise. Your care team is made up of experts in all aspects of your exact type of cancer. All of your physicians, nurses, and more collaborate to save lives.
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