Pituitary Adenoma

Overview

Pituitary adenomas are benign (noncancerous) tumors of the pituitary gland - a small structure located behind the eyes, beneath the brain. Most pituitary tumors are benign, meaning that they do not spread to distant locations in the body. Cancerous pituitary tumors are extremely rare.

The pituitary gland is a principal part of the endocrine system (the set of glands and organs that produce hormones). The pituitary is called the “master endocrine gland,” because it produces specific hormones that control the activities of other endocrine glands and organs in the body.

Pituitary adenomas usually develop in older adults, but they may occur in children. These tumors are very common, occurring in up to 20% of adults. Although most pituitary adenomas are harmless, some cause serious problems. Typically, a pituitary adenoma develops in the anterior pituitary, and its impact is determined by its size and whether it secretes hormones.

Types of Pituitary Adenomas:

  • Functional (hormone-producing) pituitary adenomas excessively secrete one or more hormones - prolactin, growth hormone (GH), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH).
  • Nonfunctional pituitary adenomas do not secrete hormones.
  • Macroadenomas are large (>1 centimeter) and may compress adjacent structures, causing serious complications such as loss of vision. Large tumors impair the pituitary’s function, causing hormone deficiencies (hypopituitarism).
  • Microadenomas are small (<1 centimeter) and rarely compress nearby tissues, but they can be harmful if they secrete excessive hormones.

Classification of Functional Pituitary Adenomas:

  • Prolactin-secreting adenomas (prolactinomas) are the most common type, and they cause hyperprolactinemia.
  • Growth hormone-secreting adenomas cause acromegaly in adults or gigantism in children.
  • Adrenocorticotropic hormone (ACTH)-secreting adenomas cause Cushing’s disease.
  • Thyroid-stimulating hormone (TSH)-secreting adenomas are rare and lead to hyperthyroidism.
  • Gonadotropin (LH and FSH)-secreting adenomas are very rare and cause reproductive dysfunction.

Causes

The underlying cause of pituitary adenomas is unknown, and there are no lifestyle or environmental factors that increase a person’s risk of developing this condition. Rare cases are linked to inherited genetic syndromes.

pituitary gland shown in a cross-section of the brain

Symptoms

The signs and symptoms of pituitary adenomas correlate with the tumor size and whether excess hormone is secreted. The onset of symptoms is gradual and early symptoms may go unnoticed for years.

Prolactin-Secreting Pituitary Adenoma (Prolactinoma)

Signs and symptoms in females:

  • Infertility
  • Loss of menstrual periods
  • Diminished libido
  • Abnormal breast milk secretion (galactorrhea).

Signs and symptoms in males:

  • Low testosterone level
  • Infertility
  • Impotency
  • Breast development.

Growth Hormone-Secreting Pituitary Adenoma

Signs and symptoms of excess GH in adults (acromegaly):

  • Enlargement of hands feet, and skull
  • Large protruding jaw
  • Deep voice
  • Large tongue
  • High blood sugars
  • Increased body hair
  • Painful joints
  • Excessive sweating
  • Thickened skin
  • Heart disease
  • Kidney stones.

Signs and symptoms of excess GH In children (gigantism):

  • Abnormally rapid growth
  • Very tall stature
  • Painful joints
  • Excessive sweating.

Adrenocorticotropic Hormone (ACTH)-Secreting Pituitary Adenoma

Excess ACTH stimulates the adrenal glands to overproduce cortisol (Cushing’s disease). Normally, cortisol maintains blood pressure and helps the body react to stressful conditions; however, too much cortisol disrupts numerous bodily functions.

Symptoms of Cushing’s disease:

  • Weight gain
  • Roundness and fullness of the face (moon facies)
  • Excess fat on the back of the neck (buffalo hump)
  • Purple stretch marks on the abdomen
  • High blood sugar
  • Hypertension
  • Increased body hair growth
  • Depression
  • Loss of libido
  • Menstrual changes
  • Osteoporosis.

Thyroid-stimulating Hormone (TSH)-Secreting Pituitary Adenoma

Excess TSH stimulates the thyroid to produce too much thyroid hormone (hyperthyroidism) and abnormally accelerates the body’s metabolism.

Symptoms of hyperthyroidism:

  • Rapid heart rate
  • Weight loss
  • Sweating
  • Tremors
  • Anxiety
  • Enlarged thyroid.

Gonadotropin-Secreting Pituitary Adenoma

Excess gonadotropins (LH and FSH) disrupt reproductive processes.

Symptoms:

  • Menstrual period changes
  • Low testosterone level in males
  • Loss of libido.

Macroadenomas

Large pituitary adenomas may cause headaches, nausea, and vomiting. Compression of the optic chiasm causes loss of peripheral vision. Injury to the posterior pituitary impairs antidiuretic hormone (ADH) production (a condition known as diabetes insipidus) and leads to excess urination, dehydration, and thirst. Additional pituitary hormone deficiencies cause infertility.

Microadenomas

Functional microadenomas are tiny, but they cause problems by secreting excessive hormones. Conversely, small, asymptomatic nonfunctional adenomas (so-called incidentalomas) are usually found on MRIs performed for other reasons.

Diagnosis

Several tests are used to diagnose pituitary tumors.

  • Visual Field ExaminationCompression of the optic chiasm causes a loss of peripheral vision on both sides.
  • Hormone TestingBlood, urine, and saliva are tested for abnormal hormone levels. Hormone levels are also tested in response to certain hormone-suppressant medications.
  • Imaging StudiesMagnetic resonance imaging (MRI) of the pituitary provides detailed pictures of the gland and surrounding structures. Computed tomography (CT) may also be obtained.

Treatment

Surgery is the predominant treatment for pituitary adenomas. Treatment is important for functional or large tumors; however, small, asymptomatic nonfunctional adenomas (incidentalomas) are closely watched and not necessarily treated unless they grow.

  • Pituitary SurgeryMost pituitary adenomas are removed through the nose (transsphenoidal approach). This approach allows neurosurgeons to remove the tumor without entering the brain. Surgery is usually more successful for small tumors than large ones. 

    Postoperative complications include hormone deficiencies such as low ACTH (secondary adrenal insufficiency) characterized by low cortisol, low blood pressure, low blood sugar, hair loss, and loss of libido. Some patients develop low vasopressin, which causes diabetes insipidus. These complications are treated with hormone replacement medications. Additional complications may include infection of the linings of the brain (meningitis), or leakage of cerebrospinal fluid from the nose.
  • MedicationsSometimes medications are prescribed in lieu of surgery or for treatment of complications after surgery. Medications are available to block the production of excess hormones or correct hormone deficiencies.
  • Radiation TherapyRadiation is used to destroy the tumor when surgery alone is inadequate or when a patient is a poor candidate for surgery. External radiation treatments are administered over a period of weeks. Another method, called Gamma Knife stereotactic radiosurgery, uses a focused beam of radiation directly precisely at the pituitary tumor. Radiation therapy does not provide immediate results and patients may take years to achieve the full effect.

Prevention

Pituitary adenomas are not associated with any known lifestyle or environmental risk factors, so there are no available methods to prevent the condition. People with a family history of pituitary tumors associated with inherited genetic syndromes should be regularly monitored for early signs of the disorder.

Sources

  • Melmed S, Kleinberg D. Chapter 9. Pituitary Masses and Tumors. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12e. Philadelphia, PA: Elsevier Saunders; 2011.
  • Pituitary Tumors. American Cancer Society website. http://www.cancer.org/cancer/pituitarytumors/detailedguide/pituitary-tumors-what-causes. Accessed May 15, 2014.
  • Pituitary Disorders. Johns Hopkins Medicine website. http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/pituitary_center/conditions/. Accessed May 15, 2014.