The pituitary gland is located under the brain. Its role is to produce hormones essential for daily body functions, including cortisol (the stress hormone), prolactin (milk production), growth hormone, and thyroid-stimulating hormone.
Consultant neurosurgeon Miss Anouk Borg explains how pituitary tumours are diagnosed and the treatment options available for patients who discover they have a tumour.
“Pituitary tumours are quite common. A tumour on your pituitary gland can disrupt the production of these hormones by either preventing them from being produced or stimulating the production of too much hormone. These changes can have a number of effects on the body. Most tumours tend to be benign (non-cancerous), and they can go unnoticed for some time—often until they are large enough to start pushing on the optic nerve, which runs above the pituitary gland. At this point, visual problems can occur (like bumping into things or noticing colour vision is affected), which may warn that something is wrong. The optician or ophthalmologist (eye specialist) may send you for a scan, which can show the tumour.
If it doesn’t affect the optic nerve, it may alternatively be picked up when hormones are disrupted and there are sudden unexplained changes in the body, irregular menstrual cycles, milky discharge from the breasts, or weight gain. Again, a scan can help to identify the pituitary tumour.
If you do discover that you have a pituitary gland tumour, there are several courses of action available to you.
A range of treatment options
If your pituitary tumour is very small and has been discovered by accident, for example, through a scan for another health concern, AND is not causing you any side effects, then a “watch and wait” approach may be recommended. You may be scanned on a regular basis to check that it is not causing any adverse effects, but otherwise no further treatment will be required unless the tumour progresses.
Medication
If your tumour is a high prolactin-producing tumour (prolactinoma) then the first line of treatment would usually be medication. This type of pituitary tumour would be monitored by both a neurosurgeon and an endocrinologist (hormone specialist). Some drugs can affect things like impulse control, so for example, if you are already on anti-psychotic medication, it might be recommended that surgery is a better first option than the medication.
Most prolactinomas respond well to medication, but if not, then surgery or gamma knife radiosurgery may be an alternative option.
Surgical options
If medication does not work, or if the tumour is impacting your vision or causing excess production of the growth hormone or cortisol, then keyhole surgery is the recommended option. This is called an endoscopic transsphenoidal pituitary operation.
Surgery takes place through the nose, and a small opening is made at the base of skull to get the tumour out. This type of surgery does not cause any facial scarring. You would only stay in hospital for two to three days, and then would usually be advised to have a six-week recovery period at home. You should avoid straining or doing heavy exercise in those six weeks, but if you have a job where you can work from home, for example, you can go back to work within a few weeks.
Like any operation, there are serious risks associated with undergoing pituitary surgery. However, the majority of patients recover well from surgery with no consequences. You may suffer with minor headaches and tiredness, which resolves by itself within a few days or weeks.
In rare cases, a normal pituitary gland may be affected by the operation, so we always test for the hormone levels after surgery. In a worst-case scenario, you may need to go on hormone replacement treatment to correct this. This is usually temporary, but in some instances, it may be a permanent change.
Radiotherapy
Another option is radiotherapy, which can either be a stand-alone treatment option or used in combination with medication/surgery.
Stereotactic radiotherapy (sometimes known as Gamma knife due to the name of the machine used) is a very precise treatment. It is given when the tumour is small, usually after surgery, as you can give a high dose of radiation on a focused area. It is usually completed within one day, without a hospital stay. Side effects can be tiredness or dizziness, which can last a few days, but tends to settle and you can go back to work straight away.
If the tumour is too big for Gamma knife surgery or it is too close to the optic nerve, then you may be referred for fractionated radiotherapy, meaning a small dose of radiation is given every day usually over a course of six weeks.
An expert team of pituitary specialists
At UCLH we deliver the highest volume of transsphenoidal surgeries in the country every year.
Our pituitary patients are extremely well supported. We have two pituitary specialist nurses who see our patients and provide advice about surgery and the post-operative care.
All nurses at the National Hospital for Neurology and Neurosurgery are specially trained to support patients with neurological problems, including pituitary patients, so they know what to expect and how to care for them. We also have the most up-to-date technical equipment in our theatres, with new endoscopes and camera stacks.
Many of our consultants are regularly involved in the latest research in this area, and so our patients are in the very best place for pituitary surgery in the UK.
Follow-up care
After pituitary gland surgery, you will need long term follow-up with MRI scans, even if all the tumour has been removed, just to ensure that the tumour has not returned.
In some cases, you might need further radiotherapy or medication, depending on your specific needs.
However, the good news is that the condition is broadly treatable, and the majority of patients will be able to live a normal life once they have received care.”
To enquire about our neurosurgery service, please call us on 020 3448 4260, email uclh.private.enquiries@nhs,net or use our 24 hour chat box.
