Pituitary tumors

Pituitary tumors arise from the pituitary gland within the base of the skull. These tumors are almost always benign. Symptoms arise when these tumors secrete hormones or becomes large enough to compress adjacent structures. Rarely, these tumors may spontaneously hemorrhage.


gradual enlargement of facial soft tissues over many years in acromegaly	enlarged soft tissues of the hand in acromegaly

Hormone Producing Tumors:
	hormone	% of tumors	symptoms
	GH, GH-PRL	26 %	enlargement of hands, feet and soft tissues of the face, heart disease, carpel tunnel, arthritis
	ACTH	13 %	moon-shaped face, humped shoulders, stretch marks, hypertension, psychosis
	ACTH		(after adrenalectomy) dark skin pigmentation
	PRL	20 %	lactation from breasts, loss of period, sterility
	TSH	2 %	hyperthyroidism, tremor, hypertension, wt. loss


Non-hormone Producing Tumors
	Null Cell Tumors	18 %	visual loss, double vision, hypopituitarism

As tumors enlarge, normal pituitary function is destroyed. This produces various hormonal deficiencies, since the pituitary controls the action of other endocrine glands. Pressure on near-by structures produces double vision, facial numbness. The nerves of vision, the optic nerves, are directly above the pituitary gland and upward growth of pituitary tumors frequently causes progressive visual loss. This visual loss is typically begins from each side of the field of vision leading to tunnel vision.

The surgical approach to pituitary tumors is through a small incision within the nose. Using an operative microscope we expose and remove the tumor through the sphenoid sinus, which lies directly behind the nose. This decompresses the optic nerves and improves vision in the majority of individuals. Abnormally high hormone levels are lowered or normalized. Smaller tumors can be cured without additional treatment, while larger tumors can recur and may additional treatment. One tactic we employ is to remove as much of the large tumors as possible and treat residual or recurrent tumors with Gamma Knife radiosurgery or stereotactic radiotherapy for complete control. The operation takes less than one hour, produces no visible scars and little pain. Patients can return home the day following surgery. Infection, cerebrospinal leak, vascular injury, double vision, visual loss, pituitary deficiency are rare sequels of this commonly performed procedure. In unusual circumstances the operative exposure is through a craniotomy, removing a window of bone in the skull to expose and remove the tumor.


side view showing tumor compression	front view showing compression


post-op views demonstrating tumor removal and decompression of the optic nerves