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Pituitary Tumors

Our Approach
City of Hope takes an aggressive approach to treating pituitary tumors and helping patients achieve the most positive outcomes possible.

Our neurosurgeons team with neuro-oncologists and radiation oncologists to provide children and adults in our care with the most advanced surgical techniques, radiation technologies, chemotherapies and immunotherapies.

About Pituitary Tumors

Pituitary tumors are tumors found in the pituitary gland, a small organ about the size of a pea in the center of the brain just above the back of the nose. The pituitary gland produces hormones that affect growth and functions of other glands in the body. Pituitary tumors may be grouped as follows:
  • Benign adenomas, which are non-cancerous. These grow very slowly and do not spread from the pituitary gland to other parts of the body.
  • Invasive adenomas, which spread to the outer covering of the brain, bones of the skull or the sinus cavity below the pituitary gland.
  • Carcinomas, which are malignant (cancer). These are pituitary tumors that have spread far from the pituitary gland in the central nervous system (brain and spinal cord) or outside of the central nervous system.

These pituitary tumors may be either functioning or nonfunctioning. Tumors that make one or more of the pituitary hormones are called functioning tumors, while those that do not make hormones are called nonfunctioning tumors. Each type of functioning tumor causes different symptoms, depending on the type of hormone that is being made by the tumor. Symptoms may also be caused if the tumor grows large and presses on nearby parts of the brain.

A Delicate Balance
Each hormone produced by the pituitary stimulates a certain target gland in the body. These include the adrenal glands, thyroid, breasts, ovaries and uterus, testes and kidneys. One exception is growth hormone, which stimulates all cells of the body.

By sensing the level of hormones that the target glands themselves are producing, the hypothalamus (another gland in the brain) and the pituitary can determine whether these target glands need additional hormonal stimulation, and how much hormone is needed.

This supply-and-demand relationship is a finely tuned system. Any changes in the complex balance of hormones, glands, and stimulation or inhibition responses can create undesirable neurological and endocrinological symptoms.

Fortunately, several strategies can be used to restore endocrine balance, including medication, surgery and/or irradiation.

Pituitary Disorders
Many different medical conditions can be caused by pituitary problems. Some of the most common disorders include:

Prolactinoma
A prolactinoma is the most common type of pituitary tumor (adenoma). These benign (non-cancerous) tumors secrete excessive amounts of prolactin, the hormone responsible for milk production.

Acromegaly
Caused by excess secretion of growth hormone  primarily due to benign pituitary tumors called pituitary adenomas  acromegaly is associated with abnormal growth of the limbs. Too much growth hormone before puberty causes increased linear growth (gigantism), while too much hormone after puberty causes periosteal bone growth (bone thickening), increased organ size and glucose intolerance.

Craniopharyngioma
Craniopharyngiomas are slow-growing, benign (nonmalignant) tumors at the base of the skull and account for up to 4 percent of primary brain tumors. Although not cancerous, they can cause many serious health problems and complications as they grow and involve other structures in the brain. They can be composed of both solid masses and cysts, and tend to adhere to structures near the pituitary gland and pituitary stalk, including the optic nerves, optic chiasm and intracranial arteries.

Cushings syndrome
Cushing's syndrome, also called hypercortisolism or hyperadrenocorticism, is a rare endocrine disorder characterized by excessive cortisol levels in the blood. These high levels are due to excess adrenocorticotropic hormone secretion. Most commonly the excess comes from a tumor of the pituitary gland or the adrenal glands.

FSH and LH tumors
These rare tumors of the pituitary secrete excess amounts of the gonadotropin hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
 

Pituitary Tumor Risk Factors

Only one proven risk factor has been found so far. Multiple endocrine neoplasia, type 1 (MEN1) is a hereditary condition that has a very high risk of developing tumors of three glands – pituitary, parathyroid and pancreas. It is inherited by half of the children of each affected parent. If the MEN1 syndrome affects your family, you should discuss biochemical or genetic testing for this condition with your doctor.

Diagnosing Pituitary Tumors

Several tests may be used to diagnose pituitary tumors, including:
  • Physical exam and history
  • Blood tests and assays:  These tests measure the levels of hormones that are produced by the pituitary or affected by it.
  • Neurologic exam:  The doctor checks for alertness, muscle strength, coordination, reflexes and response to pain. The doctor also examines the eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and brain.
  • CT or CAT (computerized axial tomography) scan:  This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
  • Echocardiogram:  This test uses sound waves to create a moving picture of the heart and major blood vessels.
  • MRI (magnetic resonance imaging):  MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.
  • Biopsy:  Tissue samples are examined under the microscope to determine what types of cells are present.
 

Pituitary Tumor Symptoms

Each type of functioning tumor causes different symptoms, depending on the type of hormone that is being made by the tumor. Symptoms may also be caused if the tumor grows large and presses on nearby parts of the brain.

Symptoms for each type may include:

Acromegaly
  • Abnormal growth of the limbs

Craniopharyngioma
  • Lack of growth
  • Delayed puberty
  • Fatigue
  • Constipation
  • Dry skin
  • Nausea
  • Low blood pressure
  • Diabetes insipidus (inability of the kidneys to concentrate urine)
  • Galactorrhea (milky discharge from the nipples)
  • Visual difficulty (if the optic nerve is involved)
  • Headache
  • Personality changes
  • Confusion
  • Depression
  • Loss of normal menstrual function in women or sexual libido
  • Obesity
  • Abnormal temperature regulation and change

Cushing's syndrome
  • Weight gain in face (moon face), above the collar bone and on back of neck (buffalo hump)
  • Skin changes
  • Easy bruising, purplish stretch marks and red cheeks
  • Excess hair growth (hirsutism) on face, neck, chest, abdomen and thighs
  • Generalized weakness and fatigue
  • Muscle loss
  • Menstrual disorders in women (amenorrhea)
  • Decreased libido
  • Hypertension
  • Diabetes
  • Depression with wide mood swings

Follicle-stimulating hormone and luteinizinghormone tumors
  • Headaches
  • Visual disturbances
  • Reduced activity of the ovaries and testes

Prolactinoma
In females, symptoms may include:
  • Irregular menstrual periods or a complete stoppage of menstruation
  • Milky discharge from the breasts (galactorrhea)
  • Decreased libido
  • Headache
  • Visual changes

In men, symptoms may include:
  • Enlargement of breast tissue (gynecomastia)
  • Infertility
  • Impotence
  • Decreased sexual interest
  • Headache
  • Visual changes
 
 

Pituitary Tumor Treatment Options

Surgery
Surgery is commonly used to treat patients with pituitary tumors. When applicable, our specialists utilize minimally invasive surgery with advanced technologies such as laparoscopy and the da Vinci S Surgical System with robotic capabilities that allows for greater precision. These surgeries feature small incisions. The result is less discomfort and blood loss with faster recovery and fewer complications.

One of the following surgical procedures may be used:
  • Endonasal transsphenoidal surgery:  Surgeons operate on the brain through the nose to remove pituitary tumors as gently as possible. This endonasal approach, developed within the last decade, unites the visual precision of a slim, tiny camera, called an endoscope, with the power of a navigation system, magnetic resonance imaging and highly specialized microscopes.
  • Endoscopic surgery:  Certain procedures may be performed through an endoscope  a thin, lighted tube that requires a small opening and accommodates tiny surgical tools. Smaller openings minimize post-operative discomfort and risk of infection. City of Hope researchers are working to develop a miniaturized surgical system that will allow brain surgeries to be even less invasive, with an even lower risk of complications.
  • Intraoperative cortical mapping:  This technology gives the surgeon a computerized map of key brain regions, including speech, motor and sensory centers. By avoiding these critical areas, the risk of neurological damage is minimized while allowing as much of the tumor to be removed as possible.
  • Image-guided surgical navigation:  In certain cases, City of Hope surgeons use this technology to guide the removal of tumors that are difficult to visualize or are located in high-risk areas. Using preoperative magnetic resonance images, this highly accurate system allows for more complete removal of the tumor.

Radiation
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. Our Division of Radiation Oncologywas the first in the western United States to offer theHelical TomoTherapy Hi-Art System, one of the first radiation therapy systems of its kind to integrate radiation therapy and tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.

The Helical TomoTherapy Hi-Art system integrates two types of technology  spiral CT scaning and intensity modulated radiation therapy, or IMRT, that produces hundreds of pencil beams of radiation (each varying in intensity) that rotate spirally around a tumor. The high dose region of radiation can be shaped or sculpted to fit the exact shape of each patients tumor, resulting in more effective and potentially curative doses to the cancer. This, in turn, reduces damage to normal tissues and offers fewer complications.

TomoTherapy is particularly useful in treating children with certain pituitary tumors. Because it operates with absolute precision, normal tissue is protected, reducing the risk of long-term cognitive problems.

Chemotherapy
Chemotherapy the use of anticancer medicines is another strategy used to combat pituitary tumors. Drugs may be given alone, or in combination with surgery and radiation therapy.

Generally, pituitary tumors are more difficult to treat with drugs than other cancers. This is because most drugs cannot cross the blood-brain barrier, a natural wall that prevents toxic chemicals from reaching certain cells. However, new drugs are being developed that can either cross the barrier or be delivered directly to the brain.
 

Pituitary Tumor Resources

All of our patients have access to City of Hope's Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs.
 
Additional Resources
 
 
 

 

 

Pituitary Tumor Research and Clinical Trials

Our aggressive pursuit to discover better ways to help patients now, not years from now,  places us among the leaders worldwide in the administration of clinical trials.  Find out more about City of Hope's Clinical Trials.

Find An Active Clinical Trial
 

Pituitary Tumors Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Kimberly Wah
Director
Phone: 213-241-7275
Email: kwah@coh.org

 
 
Division of Neurosurgery
City of Hope has some of the most advanced tools for the surgical removal of brain and spine tumors. Learn how these tools have enabled surgery of the highest precision while minimizing adverse outcomes.
 
City of Hope’s Division of Neurosurgery focuses on surgical treatment of both benign and malignant brain, spine and pituitary tumors. Our physicians are nationally-recognized experts in neurosurgery and neuro-oncology, and employ today’s leading edge therapies.

For questions or additional information, please call 626-471-7100.
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Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
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