What is a pituitary tumor?
The pea-sized pituitary gland is located behind the eyes at the base of the brain and plays a critical role in regulating the body's hormones. When a tumor forms in the pituitary gland, it is referred to as a pituitary tumor. Although most of these types of tumors are benign (noncancerous), a tumor can affect hormone production, causing a significant increase or decrease in levels of specific hormones. In extremely rare cases, pituitary tumors can become malignant (cancerous). Fortunately, when diagnosed and treated early, the majority of patients typically experience excellent outcomes.
Successfully treating a pituitary tumor requires an experienced team of specialists. At MedStar Health, our neurosurgeons, pituitary endocrinologists, neuro-ophthalmologists, and neuro-pathologists have decades of combined experience in diagnosing and treating pituitary disorders. As one of the largest pituitary centers on the east coast, we take a comprehensive, multidisciplinary approach to diagnosing and treating pituitary tumors, which leads to your best results.
Symptoms and risk factors
What are the signs of a pituitary tumor?
Pituitary tumors can grow slowly, and most may not even cause any symptoms. Pituitary tumor symptoms will vary based on the tumor's size and interference with nearby structures. For example, if a tumor compresses the optic nerve, patients may experience tunnel vision or other vision problems. If the tumor puts pressure on the brain, patients may experience:
- Headaches
- Nausea or vomiting
- Dizziness
- Disorientation
Since the pituitary gland regulates many other endocrine glands in the body, symptoms can vary depending on whether it is a functioning (producing hormones) or non-functioning (not producing hormones) tumor. Functional pituitary gland tumor symptoms related to excess hormone production or hormonal deficiencies may include:
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Cortisol imbalances
- Weight gain
- New onset or worsening diabetes
- High or low blood pressure
- Changes in mood, such as depression, irritability, and/or anxiety
- Fatigue
- Poor appetite
- Signs of Cushing’s disease
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Insulin growth factor 1 imbalances
- Acromegaly (enlarged facial features, hands, and feet)
- Loss of muscle mass
- Change in teeth, tongue, or voice
- Excessive sweating
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Prolactin imbalances
- Irregular menstrual cycles
- Infertility
- Enlargement of breasts (in men)
- Other signs of hyperprolactinemia
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Testosterone or estrogen imbalances
- Infertility
- Changes in bodily or facial hair growth
- Decreased libido
Other medical conditions may also cause hormonal imbalances and related symptoms, so it's important to get evaluated by an endocrinologist who can determine the root of your concerns.
Who is at risk for developing a pituitary tumor?
Most people with these tumors have no associated risk factors. They affect both men and women of all ages, although certain types of these tumors may be more common in different age groups and genders. Some people may be more likely to develop a pituitary tumor if they:
- Have a family history of pituitary tumors
- Have a genetic syndrome, such as Multiple endocrine neoplasia type 1 (MEN 1), McCune-Albright syndrome, and Carney complex
Screening and prevention
Can you prevent pituitary tumors?
Doctors do not know what causes pituitary tumors to develop, and many people live with them their entire lives without knowing it. As a result, there is nothing you can do to prevent these tumors. However, if you have a high risk based on a known genetic condition or hereditary gene mutation, you may be able to detect them early before they cause problems. At MedStar Health, our board-certified genetic counselors can help you understand your inherited risk of these tumors and determine the appropriate next steps for screening.
Pituitary tumor diagnosis
How are these tumors diagnosed?
These tumors are often found incidentally on imaging conducted for other medical conditions. If the tumor is large enough that it is causing symptoms, your doctor will ask you to thoroughly describe your symptoms and will want to discuss your medical history. If your doctor suspects that a tumor may be causing your symptoms, they will want to perform diagnostic testing. Some of the tests used to diagnose a pituitary tumor include:
- Pituitary functioning hormone test: This is a blood test used to determine whether the pituitary tumor is or isn't producing hormones.
- Blood and urine tests: These tests detect overproduction or underproduction of various hormones.
- Imaging: With either a CT scan or MRI, your physician can verify the existence of a pituitary tumor and determine its exact size and placement.
- Vision Tests: With an eye test, your doctor can determine whether the pituitary tumor has grown large enough to significantly affect your vision.
After examining the results of one or more of these tests, your doctor may inform you that you have a pituitary tumor. Since the gland affects so many different bodily functions, the specific diagnosis is based on where the tumor is causing the majority of symptoms.
Types of pituitary tumors
What is the most common type of pituitary gland tumor?
Most pituitary tumors are functioning pituitary adenomas, which are benign growths that are further classified based on their size and the type of hormone they're secreting. Microadenomas are smaller than one centimeter in diameter, while macroadenomas are larger than one centimeter in diameter.
Functioning tumors can affect the following hormones:
- Adrenocorticotropic hormone (ACTH): ACTH regulates stress hormones produced in the adrenal gland, such as cortisol. Excessive ACTH can lead to rapid weight gain, changes in mood, high blood pressure, and more.
- Prolactin: Commonly known as prolactinomas, these tumors secrete excessive prolactin, affecting fertility, milk production, and more.
- Growth hormone: If the body produces too much growth hormone, the face, hands, or feet can grow abnormally large (acromegaly).
- Thyroid-stimulating hormone (TSH): When pituitary adenomas make too much (TSH), it can cause hyperthyroidism. In contrast, TSH underproduction can make someone sluggish and tired.
- Gonadotropin-releasing hormones: These reproductive hormones help to regulate estrogen and progesterone.
If a tumor is not producing hormones, it is referred to as non-functioning pituitary adenoma. Many of these tumors do not cause any problems and can be monitored for years before needing treatment.
In extremely rare instances, pituitary tumors can be cancerous (pituitary carcinoma).
Treatment
How are pituitary tumors treated?
Treatment varies according to the type and size of the tumor, whether or not it is affecting nearby structures, and other factors. For example, a small, non-functioning tumor may only need monitoring for several years, whereas a large, functional tumor may require surgery.
With early detection and treatment, the prognosis for recovery is generally excellent. At MedStar Health, our pituitary experts include neurosurgeons, endocrinologists, and neuro-ophthalmologists who work together to determine the right approach for treating your particular tumor. Depending on your diagnosis, your treatment may involve one or more of the following:
- Medication: Certain drugs can suppress the overproduction of hormones and help reduce tumor size
- Surgery: This is the most common option, especially in cases where the tumor is putting pressure on the optic nerve and causing vision problems
- Radiation: This option can be used along with surgery or by itself. The two types of radiation therapy used are external beam radiation and gamma-knife radiosurgery
Surgery
If the tumor is symptomatic, it may be necessary to remove it surgically. The surgical technique used will depend on the tumor's size, extent, and location. Most commonly, our neurosurgeons use a minimally invasive approach called transsphenoidal surgery. Transsphenoidal techniques use endoscopic instruments to remove the pituitary tumor through the nasal cavity or behind the nose through the base of the skull. This type of surgery minimizes risks associated with more invasive, open surgical procedures.
At MedStar Health, our neurosurgeons use the latest advances in technology and intraoperative imaging to make pituitary surgery safer, faster, and more successful than ever. Intraoperative computed tomography (CT) scanners allow our surgeons to view the inside of the body at the time of surgery, which enhances surgical accuracy and minimizes the risk of complications.
Following surgery, most patients are monitored in the hospital for approximately three days so we can monitor hormone function as your body recovers. Some patients may experience sinus pressure and/or congestion for a few weeks following surgery, but most return to work within two-to-three weeks. After surgery, some individuals may need adjuvant radiation and/or medication therapy in order to completely remove the tumor and restore hormone levels in the body.
Medication
Sometimes, functioning pituitary tumors can be treated using medication that restores the balance of hormones in the body. For example, a prolactinoma may be treated with a dopamine agonist, which can reduce prolactin levels and slow or shrink tumor growth. If the tumor doesn't respond to the medication, your care team may recommend other treatment options.
Certain drugs may also be given orally or via injections to further shrink tumors after surgery or help to manage hormone secretion and related symptoms. At MedStar Health, our endocrinologists have extensive experience and training in developing an individualized treatment plan for patients with pituitary tumors.
Radiation therapy
If the tumor cannot be removed, radiation therapy may be used to shrink the tumor. Radiation therapy can also be used in conjunction with surgery to target the tumor. Our radiation oncologists have exceptional experience using the latest radiation technologies to deliver targeted radiation while preserving the surrounding healthy tissue, such as the brain and nearby nerves. These advanced technologies include:
- Stereotactic radiosurgery (SRS): At MedStar Health, we offer CyberKnife, a form of SRS, that allows us to tailor radiation delivery with submillimeter precision based on the tumor's exact size and shape.
- Proton beam therapy: We were the first in the region to offer this sophisticated radiation technology that delivers high-energy protons directly to the tumor site. Because this form of radiation does not continue through the body beyond the tumor, there is less impact to nearby critical structures than traditional radiation.
Looking for expert care?
With multiple locations throughout the region, including the MedStar Pituitary Center, patients have access to many of the nation’s renowned cancer specialists offering high-quality care, second opinions, and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.
Our providers
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MedStar Pituitary Center
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Edward Fiore Aulisi, MBBS
Spine Surgery & Neurosurgery
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Stanley Hung-Hsuan Chia, MD
Otolaryngology
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Susmeeta Tewari Sharma, MBBS
Endocrinology
Show All MedStar Pituitary Center
Our locations
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MedStar Georgetown Cancer Institute at MedStar Georgetown University Hospital
3800 Reservoir Rd. NW Washington, DC 20007
MedStar Franklin Square Cancer Center at Loch Raven Campus
5601 Loch Raven Blvd. Russell Morgan Building First Floor Baltimore, MD 21239
MedStar Georgetown Cancer Institute at MedStar Health Bel Air Medical Campus
12 MedStar Blvd. Ste. 180 Bel Air, MD 21015
MedStar Georgetown Cancer Institute at MedStar Franklin Square Medical Center
9103 Franklin Square Dr. The Harry and Jeanette Weinberg Cancer Institute Suite 220 Baltimore, MD 21237
MedStar Georgetown Cancer Institute at MedStar Southern Maryland Hospital
7501 Surratts Rd. Ste. 101 Clinton, MD 20735
MedStar Pituitary Center
110 Irving Street NW. Washington, D.C., 20010
Why choose us
As one of the most experienced pituitary tumor teams in the mid-Atlantic region, our experts are honored to care for hundreds of patients with these types of tumors every year. Patients from all over the world seek pituitary tumor treatment here because:
- We combine sub-specialized expertise to deliver the most comprehensive care available. We are the largest multidisciplinary pituitary tumor program in the Washington, D.C., area to have neurosurgeons experienced with pituitary disorders, pituitary endocrinologists, neuro-ophthalmologists, otolaryngology specialists, neuro-radiologists, and more working together to tailor care for each and every patient. These internationally-known experts meet regularly in multidisciplinary tumor boards to collectively determine the best approach for each patient. As a result, you benefit from the input of specialists in several fields without requiring additional travel.
- We use the most advanced technology for more accurate, less invasive treatment approaches. From unmatched precision with stereotactic radiosurgery to minimally invasive surgical procedures that reduce the risk of complications and improve surgical accuracy, we're equipped with state-of-the-art technology that helps us achieve your best outcomes.
- We make it easy to get the timely, coordinated, and convenient care you deserve. Because we work as a team, you'll benefit from seeing several specialists in one office visit where you can also complete diagnostic testing, surgery, and more—all in the same location. We also offer virtual visits via telehealth, so you can access specialized care from the comfort of your home, wherever you live. With the help of our dedicated nurse navigator, you'll have peace of mind and the answers you need throughout your entire journey, from diagnosis to follow-up years after treatment.
Awards and recognition
Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)
Numerous surgeons, medical oncologists, and radiation oncologists recognized as "Top Doctors" by both Baltimore Magazine and the Washingtonian
Magnet® designation from the American Nurses Credentialing Center (ANCC)
Clinical trials and research
Clinical trials
Clinical trials investigate new treatments to test their safety and effectiveness. Depending on your diagnosis, your care team may recommend a clinical trial as part of your treatment if it offers you a personal benefit.
Research
Our pituitary experts continue exploring new and better ways to diagnose and treat these tumors with minimally invasive techniques. From intraoperative imaging to neuro-navigation technology, we are pioneers in surgical approaches that lead to improved surgical accuracy and results.