The brain is an elaborately designed organ that has well organized tissues and nerves, running the entire body and controlling its vital functions. The pituitary gland is a part of our brain. It is a small, bean-sized organ in the midline region at the brain base, in a bony projection called the “sella turcica.” The pituitary is the “master gland”, controlling a lot of other glands and “target” organs in our body, such as the thyroid and adrenals, the testes and ovaries. The pituitary gland has the master endocrine function, that is it releases hormones into the blood stream, which affect distant glands or organs in the body. The pituitary produces the following hormones.
- Adrenocorticotropic Hormone (ACTH) : This controls cortisol, which in turn controls blood pressure, sugar and salt levels.
- Growth Hormone (GH) : Controls bone growth, height and body proportions.
- Prolactin (PRL) : Controls milk production in females, sex drive and sperm counts in males.
- Thyroid Stimulating Hormone (TSH) : Controls thyroid stimulating functions such as body metabolism, the heart rate and appetite.
What are pituitary tumors ?
Pituitary Tumours are basically tumours of the Pituitary Gland.
What are the types of pituitary tumors ?
There are several types of cancer that can initiate in the pituitary gland. They can either be benign or malignant. Pituitary tumours are classified as either functional (producing hormones) or non-functional (not producing hormones). Most pituitary tumours are functional.
- Pituitary Adenoma : The most common pituitary tumour is the “pituitary adenoma” —adeno meaning gland and oma meaning tumour. Most pituitary adenomas develop in the front two-thirds area of the pituitary gland. That area is the adenohypophysis, otherwise known as the anterior pituitary. The types of adenomas are classified based on the hormone they produce.a. Prolactin-Producing Adenomas (Prolactinomas)- most common.
b.Growth Hormone-Secreting Adenomas- also common.
c. Corticotropin (ACTH)- Secreting Adenomas- rare.
d. Gonadotropin (LH and FSH)- Secreting Adenomas- extremely rare. - Pituitary Carcinoma :Pituitary carcinoma is a tumour that begins in the pituitary gland and later spreads, either within the brain or elsewhere outside the central nervous system.These tumours are generally therapy resistant, locally recurring and metastasizing to the spinal canal and other organs of the body. A majority of pituitary carcinomas are of the functional kind.
What are the clinical features of pituitary tumors ?
As a majority of pituitary tumours are functional or hormone secreting tumours, the most frequent symptoms are due to excess hormones. Irregular or absent menstrual periods (amenorrhea), breast milk being produced without pregnancy (galactorrhea), excessive body growth (acromegaly or gigantism), Cushing’s syndrome, a hyperactive thyroid all may point to a pituitary tumour. Changes in special senses like vision and hearing, headache, nausea and vomiting could also result due to the non-functional pituitary tumours.
How are pituitary tumors diagnosed ?
An endocrinologist has to be consulted for aiding in diagnosis and in medical therapy of the tumour.
A complete physical examination of the body is mandatory.
- Hormone Tests: Special blood and urine tests are needed to gauge hormone levels and if the pituitary gland is the source of excess hormones.
- Imaging Tests: Important diagnostic tests include the following such as X- rays, CT Scan, MRI Scan or PET Scans. Magnetic Resonance Imaging (MRI) & Computed Tomography (CT) Scans are the imaging tests used most often for diagnosis of pituitary tumours.These scans can detect asymptomatic pituitary tumours, as well. To determine the exact extent of disease, these tests may need to be performed so doctors can view, assess and judge the cancer and determine how far it has progressed or spread.
- Biopsy : Removed tissue examined under a microscope by a pathologist is the only sure-shot way to make a definitive cancer diagnosis.
However, a biopsy is not typically recommended for a pituitary tumour. The hormonal assessment tests for most adenomas are highly accurate, so a biopsy is not likely to supply more information. Another factor is that biopsies in this highly important part of the body can have some adverse effects. Thirdly, some adenomas can be treated without surgery or biopsy, with medicines or radiation therapy.
How are pituitary tumors staged & graded ?
Pituitary adenomas are not staged and graded, and pituitary carcinomas are quite rare, for a sound staging and grading system to have been established.
Grade and Stage describe the brain tumour, helping to provide guidance for the oncologist in choosing the best treatment option(s). Staging is a careful attempt to find out the exact extent and spread of the cancer. The higher the stage the further the cancer has grown away from its original site in the pituitary gland.
How are pituitary tumors treated ?
A neurosurgeon will have to be consulted, and either a single therapy or a combination of treatments will be decided for you by a panel of oncosurgeons, radiologists, endocrinologists and your general physician. As the pituitary gland is primary in control of other glands, treating a pituitary tumour needs an active coordinated multi-disciplinary health care. Treatment of a pituitary tumour is decided by the tumour’s hormonal activity, the tumour size and location, as well as the age and overall health of the affected person. The pituitary tumours are mostly adenomas, which are benign and mostly successfully treatable. Some tumours can be treated effectively with medicines while some others need surgery. The treatments for Pituitary Tumours can either be used singly or in combination.
- Surgery : Surgical treatments for brain cancer include Transsphenoidal Surgery and craniotomy.a. Transsphenoidal Surgery is the most common surgery to eliminate pituitary tumours. Transsphenoidal means that the surgical approach is through the sphenoid sinus, a hollow space in the skull behind the nasal passages.
b. Craniotomy : Removal of the brain tumour by making a surgical hole or opening in the front or sides of the skull, under general anaesthesia or partial anaesthesia. Although the craniotomy has increased chances of brain injury than transsphenoidal surgery, it is in fact better for large and complex lesions as the surgeon is able to see, visualize and remove the tumour. - Radiation Therapy : A cancer treatment that utilizes high-energy x-rays or basically radiation to eradicate cancer cells. Radiation can be used on select patients if surgery is not a good option. Radiation therapy can also be used post surgery to kill any remaining cancer cells.
- Medicinal Therapy : There are a range of medicines to treat functional pituitary tumours. They combat tumours that produce hormones.
What is the care to be taken after the removal of a pituitary tumor ?
Once you are recovered from surgery, radiation therapy and/or medical treatment, your doctors will make a schedule for follow-up MRI scans and hormone testing. These will gauge the effectiveness of therapy, assure normal hormone balance and check for possible tumour re-growth.Many people with pituitary tumours are monitored regularly by an endocrinologist. Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the brain with radiography, MRI or CT scans because of the risk of possible recurrences.
Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely. Hormonal replacement therapy might also be required in cases of pituitary gland removal.
How to find and reach cancer specialists for pituitary tumor treatment ?
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
