MedStar Pituitary Center Outstanding Results for Pituitary Surgery

The pituitary gland is about the size of a pea, and it’s located behind the eyes and the bridge of the nose on the bottom side of the brain. Though it’s tiny, it can cause huge problems if a tumor develops there.

When someone finds out that they have a pituitary tumor, their first reaction usually is one of fear or worry. They might wonder, “What’s going to happen to me? Where do I go to get help?” At other centers, answering these questions can be a challenge. It’s often difficult to navigate complex routes of testing, diagnosis, and treatment for pituitary tumors.

But it’s different for patients at the MedStar Pituitary Center at MedStar Washington Hospital Center. Our center brings together pituitary specialists with a single goal: giving patients expert care for pituitary tumors, including surgery, if needed. And our dedicated team produces results:

• Less than five percent of our pituitary surgery patients need hormone replacement therapy after surgery, compared to 15 to 20 percent at other centers
• The typical rate of pituitary tumors recurring, or coming back after surgery, is less than 15 percent, but ours is less than two percent; and for our patients who make it to five years after surgery without recurrence, their risk drops to less than one percent

WATCH: Dr. Aulisi discusses the MedStar Pituitary Center

Understanding Pituitary Tumors

The pituitary gland is what we call the “master gland,” as it produces hormones that help control many of the body’s processes, including:

• Healthy bone and muscle mass
• Normal function of the reproductive system
• Temperature regulation
• Thyroid function

It’s often surprising to people when I tell them how common it is to have a pituitary tumor. One review of multiple studies found that the prevalence of noncancerous pituitary tumors is about 17 percent. But the real number might be even higher. The American Cancer Society notes that as many as one in four people might have a pituitary tumor without knowing it.

Fortunately, most of these tumors never cause problems and don’t need treatment. In fact, we often see patients with pituitary tumors that are picked up during imaging tests for some other reason, such as a head injury or a car accident.

On occasion, some patients will notice the effects of pituitary tumors and get checked out by their primary care doctors, who refer them to us. Once a patient is referred to the Pituitary Center, we move quickly:

• They’ll likely see me and one of our endocrinologists on the same day to determine whether the tumor is affecting their hormones.
• They’ll see our neuro-ophthalmologist to evaluate their eye function within the same week, as large pituitary tumors can press on the optic nerve and cause vision problems.
• In most cases, patients can avoid surgery by taking highly effective medications to control tumor growth.

But if a patient needs surgery due to severe symptoms or uncontrolled tumor growth, we’ll schedule it within a couple of weeks of their first appointment with us.

WATCH: Learn about the team approach at the MedStar Pituitary Center

We are a national referral center for pituitary tumors, and part of the reason for that is our high level of expertise in treating them surgically. We see 400 to 500 patients in the Pituitary Center each year. Of those, about a quarter to a third need surgery.

Pituitary Surgery Options

My colleague, otolaryngologist Stanley Chia, MD, and I most often remove pituitary tumors with a minimally invasive approach, which involves smaller incisions and less pain for patients. For many patients, it’s more like sinus surgery than brain surgery in terms of the impact on them. We use two minimally invasive techniques:

• Transsphenoidal: through a small incision in the nose or under the upper lip, along the cartilage that separates the nostrils, and into the brain
• Endonasal, or neuroendoscopic: through a small incision in the back of the nose and into the brain

If a patient isn’t a good candidate for one of these minimally invasive techniques, I can operate through an approach called a craniotomy, which is an opening I make in the patient’s skull.

We also have an advantage over every other hospital in the mid-Atlantic region: our advanced imaging tool, the Airo Mobile Intraoperative CT system. The Airo scanner gives us 3D image guidance that’s accurate to less than a millimeter. We can scan our patients during surgery to make sure we removed all of their tumor, and the 3D guidance gives us never-before-achieved surgical accuracy amid the delicate tissues around the pituitary gland to reduce the risk of damage to the blood vessels or nerves around the eyes and brain.

Recovery after Pituitary Tumor Surgery

We usually keep patients in the hospital for at least a few days after surgery. It’s important to monitor changes in endocrine function that can occur within the first two to three days after removal of a pituitary tumor. Patients need expert, inpatient care during this time because they can get sick quickly at home without monitoring.

After our patients go home, they are usually off work for one to two weeks after minimally invasive surgery or several weeks after a craniotomy. During this time, they are under activity restrictions, which typically include no:

• Bending at the waist
• Blowing the nose
• Heavy lifting
• Twisting at the waist

We also tell patients to watch for clear, watery drainage from the nose, which could be a sign of a leakage of cerebrospinal fluid (CSF), a potentially life-threatening condition. Some centers’ rates of patients with CSF leaks after surgery is as high as 30 percent, whereas ours is less than five percent.

A small number of patients will need to start hormone-replacement therapy (HRT) after their pituitary surgery, depending on the location of their tumor and how it affected their body’s hormone levels. And some patients who were on HRT before their surgery can stop taking it afterward. One of the more common benefits of pituitary surgery we see is increased fertility in women whose tumors affected their hormone levels.

Better Results for Patients after Pituitary Surgery

We are aggressive with tumor removal and treatment after surgery, such as radiation therapy, to provide the best results for our patients. And our persistence and precision pay off in successful patient outcomes. I recall a patient who previously had undergone pituitary surgery at another center. The surgeons there failed to remove her entire tumor, and she also experienced a CSF leak that wouldn’t stop, putting her at serious risk for meningitis. She was near death when she came to us, and her family was understandably hesitant for her to have another surgery. After answering their questions and thoroughly explaining the recommended procedure, we were able to find and remove what remained of her tumor and repair her CSF leak. Ten years later, this patient is doing well, but there’s no question she would have died without the care she received at MedStar Washington Hospital Center and the MedStar Pituitary Center.

Through this process of diagnosis, treatment, and follow-up care, all of us at the Pituitary Center form lifelong bonds with our patients. We check in with our patients over the years, and many refer their friends and loved ones to us if they develop pituitary issues of their own.

Everything has to come together for patients who have pituitary tumors. Someone has to notice their condition, they have to get an accurate diagnosis, and they have to find a team of experts to provide the care they need. My teammates at the MedStar Pituitary Center and I are dedicated to making that happen every day for each of our patients.