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Guidelines for sites linking to mayoclinic.orgAfter a pituitary tumor is found, the physician discusses treatment options with the patient and family to determine the most appropriate treatment plan based on the type of tumor present. Most pituitary tumors are nonfunctioning, meaning they do not produce hormones. Functioning pituitary tumors, however, cause an overproduction of hormones such as prolactin, growth hormone, thyroid-stimulating hormone and adrenocorticotropic hormone.
Observation, medications and surgery are the most commonly used treatments, alone or in combination. Radiation may be recommended in more advanced cases.
Sixty percent to 70 percent of small, nonfunctioning pituitary tumors are carefully observed over time and do not require treatment. Treatment is considered if the tumor grows and causes symptoms. If there is no growth, observation is continued.
Treatment with medications may help block excess hormone secretion and can sometimes shrink certain types of pituitary tumors. Prolactin hormone-producing tumors are often treated with bromocriptine and cabergoline. These medications decrease prolactin secretion and usually reduce tumor size. They are generally so effective that surgery is not necessary.
Growth hormone-producing tumors can be treated with two classes of medications. These medications are typically recommended when surgery has been unsuccessful in treating excess hormone production:
Surgery is the primary treatment recommendation for pituitary tumors. The effectiveness of surgery depends on tumor type, location, size, and whether it has spread into nearby tissues. Mayo Clinic pathologists are renowned for their specialized expertise in identifying the type of pituitary tumor present, which is essential in determining the appropriate treatment.
Transphenoidal endoscopic surgery
In this surgery, the pituitary tumor is removed through the nasal cavity using a microscope and endoscope-assisted technique that results in no visible incision. Traditionally, this approach was done through an external incision under the lip.
Mayo Clinic surgeons helped develop the transphenoidal endoscopic tumor removal technique and began using it in the mid-1990s. Mayo was also among the first medical centers in the United States to perform the modified surgery. Mayo surgeons perform more than 100 transphenoidal endoscopic tumor removal procedures annually.
This surgery has three significant advantages:
This technique also requires a shorter operating time and hospital stay than the traditional method. Most patients stay in the hospital overnight and experience a dull headache for several hours up to several days after surgery.
If the tumor is small, the cure rates after surgery at Mayo Clinic are greater than 80 percent. If the tumor is large or has invaded the nearby eye nerves or brain tissue, removing the entire tumor becomes more difficult. But, in most cases, the majority of the tumor can be removed successfully, and symptoms alleviated.
Radiation uses high-energy rays to destroy tumors. Radiation therapy is often recommended when pituitary tumors persist or return after surgery and cause symptoms not relieved by medications. It also may be used if surgery is not possible.
Stereotactic radiosurgery is the most commonly recommended treatment when surgery has not been successful. Neurosurgeons and radiation therapists at Mayo Clinic have extensive expertise and experience in performing stereotactic radiosugery. This technology allows high doses of radiation to be delivered to the tumor with minimal exposure to surrounding healthy tissue. No incision is made and general anesthesia is not required for adults. In effect, it is surgery without a scalpel — thus, the name radiosurgery.
The procedure may be used with external-beam radiation, especially for tumors in deep or sensitive areas of the brain, where surgical removal is dangerous.
Like conventional radiation therapy, the benefit of stereotactic radiation also is not immediate and may take months or years to be fully effective. Unfortunately, this therapy cannot be used for tumors in close proximity to important nerves, such as those needed for vision.
Hundreds of patients have undergone stereotactic radiosurgery treatment for pituitary tumors at Mayo Clinic. A 2007 Mayo study of Gamma Knife radiosurgery found that tumor growth was controlled in 95 percent of patients with nonfunctioning pituitary tumors. A 2008 Mayo study showed that tumor remission rates for patients with adrenocorticotropic-producing and growth-hormone producing functioning tumors following stereotactic radiosurgery are higher than for those with prolactin-producing tumors.
This traditional therapy delivers radiation from outside the body. Outpatient radiation treatments usually are given five times a week for four to six weeks.
Although effective, this therapy has some disadvantages. It can take years before the tumor growth and/or hormone production are fully controlled. Also, this therapy cannot avoid some damage to surrounding normal pituitary cells and brain tissue around the pituitary gland. In most cases, normal pituitary function will eventually be lost after 10 years.
This technique delivers carefully targeted radiation to areas of tumor growth over the course of several visits. The treatment involves multiple therapy sessions that deliver smaller units of radiation, to avoid damaging normal brain tissues and eye nerves, which cannot tolerate a single unit of high-level radiation. The number of treatments depends on tumor size and location.
Surgeons use this technique to approach the tumor through an incision in the upper part of the skull. Usually, it is the procedure of choice for large and complicated tumors. It also is recommended when the pituitary tumor is in a location that cannot be accessed using the transphenoidal endoscopic technique.
Chemotherapy can decrease excess hormone production from pituitary tumors, or block the effects of these hormones. This treatment is an option when the tumor has spread beyond the pituitary gland.
Read an article, written for physicians, on endoscopic transnasal surgery for pituitary tumors.
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