Pituitary Tumour 

Pituitary tumours affect about 1 in every 1,000 people, though many never know they have one. While usually benign, these growths in the pituitary gland can disrupt essential hormones that control many body functions. This article explores the common signs and symptoms of pituitary tumours, their causes, available treatments, and when to consult a doctor. 

What is a Pituitary Tumour? 

A pituitary tumour is an abnormal overgrowth that develops in the pituitary gland, a pea- sized organ located at the base of the brain behind the nose. The pituitary gland, often called the "master gland," controls and coordinates the release of hormones that regulate many vital body functions. 
These tumours are typically classified into the following main categories based on their size: 

• Microadenomas: Tumours smaller than 1 centimetre 
• Macroadenomas: Tumours 1 centimetre or larger 
• Giant adenomas: Tumours 4 centimetres or larger 

Most pituitary tumours are benign (non-cancerous) and are called adenomas. They represent about 10-15% of all tumours that develop within the skull. These pituitary tumours can be either functional or non-functional. Functional tumours produce excess hormones, while non-functional tumours do not affect hormone production but may press against nearby structures. 

At least half of all pituitary adenomas are non-functional. However, even these non-hormone-producing tumours can cause problems if they grow large enough to press on surrounding tissues or nerves. Malignant (cancerous) pituitary tumours are extremely rare and can metastasise to other parts of the brain or body if left untreated. 

Studies show that approximately 1 in 4 people may have small pituitary tumours without knowing it. These tumours can occur at any age but are most common in people in their 30s or 40s. Most pituitary tumours grow slowly and stay within the pituitary gland or surrounding tissue. 

Symptoms of Pituitary Tumour 

Vision problems are often the first noticeable signs when a pituitary tumour grows large enough to press on nearby optic nerves. Patients may experience: 

• Loss of peripheral (side) vision 
• Blurred or double vision 
• Difficulty with eye movement 
• Drooping eyelids 
• Headaches associated with pituitary tumours typically occur in the forehead or behind the eyes. These headaches are usually steady and can affect one or both sides of the head. 
• In some cases, facial pain may also develop. 

When a pituitary tumour affects hormone production, it can cause various symptoms depending on which hormones are involved. Common hormonal symptoms include: 

• Unexplained weight changes 
• Irregular menstrual cycles in women 
• Decreased sex drive 
• Fatigue or weakness 
• Feeling unusually cold or hot 
• Changes in body hair growth. 
• Mood changes 

Causes and Risk Factors of Pituitary Tumour 

• Genetic Syndromes play a significant role in the development of pituitary tumours. Several inherited conditions can increase a person's risk: 
  • Multiple Endocrine Neoplasia Type 1 (MEN1) - affects about 40% of patients with this syndrome 
  • Carney Complex - causes various types of tumours and skin changes 
  • Familial Isolated Pituitary Adenoma (FIPA) - accounts for 2-4% of all pituitary tumour cases 
  • McCune-Albright Syndrome - characterised by bone problems and hormone issues 
• Family History can increase the risk of developing pituitary tumours, though this is relatively rare. When pituitary tumours run in families, they often appear as part of these genetic syndromes, with a 50% chance of being passed to children. 
• Women under 30 show higher occurrence rates than men, while this pattern reverses after age 30. 
• Demographic factors also influence tumour development. Studies show higher incidence rates in certain populations. Research has also indicated that Black individuals have higher incidence rates compared to other ethnic groups, though the exact reasons remain unclear. 

Complications of Pituitary Tumour 

Major Complications include: 

• Vision problems, including partial or complete vision loss 
• High blood pressure and blood sugar issues 
• Bone loss and heart problems 
• Cognitive difficulties affecting thinking and memory 
• Seizures, particularly focal seizures with impaired awareness 

A rare but potentially life-threatening complication is pituitary apoplexy, which occurs when sudden bleeding develops in the tumour. This condition requires immediate emergency care and presents with severe headaches, vision problems, and confusion. 

Some patients who undergo radiation therapy may experience delayed complications, as the treatment can affect the pituitary gland's function years later. 

Diagnosis 

The diagnosis of pituitary tumours involves several key tests: 

• Blood Tests: Measure hormone levels to detect imbalances 
• Vision Assessment: Evaluates peripheral vision and visual field changes 
• Magnetic Resonance Imaging (MRI): Provides detailed images of the pituitary gland 
• Urine Tests: Checks hormone levels over 24 hours 
• Dynamic Testing: Measures how hormone levels change in response to specific medications

Treatment 

Doctors typically consider three main treatment approaches: 

• Surgery: The most common treatment, especially for larger tumours. For most patients, transsphenoidal surgery serves as the primary treatment option. During this procedure, surgeons access the tumour through the nose, avoiding any external incisions. This approach proves particularly effective for smaller tumours and carries minimal risks compared to traditional surgery. 
• Radiation Therapy: It plays a vital role when surgery isn't possible or doesn't remove the entire tumour. Modern techniques like stereotactic radiosurgery can target the tumour precisely while protecting surrounding brain tissue. 
• Medication: Particularly effective for hormone-producing tumours. Medical therapy helps control hormone levels in patients with functioning tumours. Different medications target specific types of hormone production. For example, prolactin- producing tumours often respond well to medication alone, 
• Observation: Some small, non-functioning tumours that aren't causing symptoms may simply need regular monitoring rather than immediate treatment. This approach, called watchful waiting, involves regular MRI scans and hormone level checks to track any changes. 

When to See a Doctor 

Warning pituitary tumour signs that require immediate medical guidance include: 

• Sudden, severe headaches with vision changes 
• Unexplained changes in peripheral vision 
• Rapid onset of extreme fatigue 
• Unexpected changes in body temperature regulation 
• Sudden mood or personality changes 

Prevention 

Key preventive measures that doctors recommend include: 

• Maintaining regular medical check-ups for early detection 
• Minimising unnecessary radiation exposure 
• Following a balanced, nutritious diet 
• Engaging in regular physical activity 
• Managing overall health through lifestyle choices 
• For individuals with a family history of endocrine disorders, genetic counselling plays a 
• crucial role in prevention strategies. 
• Doctors advise following appropriate safety guidelines during imaging procedures and limiting unnecessary radiation exposure when possible. 

Conclusion 

Doctors stress the importance of recognising warning signs and seeking timely medical attention. Regular check-ups, especially for people with genetic risk factors, play a vital role in managing these conditions effectively. Modern diagnostic tools and treatment approaches help medical teams provide personalised care plans for each patient. 

FAQS 

1. Is pituitary cancer curable? 

Most pituitary tumours are benign (non-cancerous) and highly treatable. Less than 1% of all pituitary tumours are malignant. With proper medical intervention and regular monitoring, patients can expect positive outcomes. Pituitary tumour treatment success depends on early detection and the specific type of tumour. 

2. How do pituitary tumours start? 

Pituitary tumours develop from abnormal cell growth in the pituitary gland tissue. These growths typically result from genetic mutations in somatic cells, leading to clonal expansion. While the exact trigger remains unknown, certain inherited conditions can increase the risk of tumour development. 

3. How do I test for a pituitary tumour? 

Diagnosis involves several key tests: 

• Blood test and urine analysis to measure hormone levels
• MRI scans with contrast dye for detailed imaging 
• Vision tests to check for any impact on eyesight 

4. Who is at risk for a pituitary tumour? 

Risk factors for developing pituitary tumours include: 

• People with inherited genetic syndromes like MEN1 
• Individuals with a family history of endocrine disorders 
• Those with certain genetic mutations 

5. What age are pituitary tumours common? 

Pituitary tumours can occur at any age but are most frequently diagnosed in adults between 30 and 60 years old. Women under 30 show higher occurrence rates than men, while this pattern reverses after age 30. Diagnosis peaks between ages 40 to 60 years. 

6. What foods should you avoid if you have a pituitary tumour? 

There is no peculiar diet that doctors recommend for all pituitary tumour patients. However, doctors suggest maintaining a balanced diet enriched in lean proteins, fruits, and vegetables while limiting processed foods and excess sugars. Individual dietary requirements may vary based on specific symptoms and treatments.

Dr. Ankur Sanghvi

MBBS, MS, Mch (Neuro)
Ganga CARE Hospital Limited, Nagpur

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