Introduction

Pituitary tumours are relatively rare and a GP may only ever see one or two patients with this condition. As the tumours may affect any part of the pituitary (or Hypothalamus), the symptoms are wide-ranging and may not be recognised by the patient for some years. However, certain clusters of symptoms can give an indication of possible pituitary dysfunction. Patients are often aged between 30-60 years and may have chronic headache and visual symptoms, particularly deteriorating peripheral vision. There may be symptoms of primary hormone hypersecretion such as Hyperprolactinaemia, Acromegaly or Cushing's disease, or the symptoms may be much more general such as fatigue, Amenorrhoea, loss of libido and erectile dysfunction associated with pituitary hypofunction. More rarely, a patient may complain of polyuria as a result of Diabetes Insipidus.

Presenting symptoms

• pressure effects - headache and visual disturbance (eg loss of temporal vision)
• inappropriate hormone secretion eg PRL (hyperprolactinaemia), ACTH (Cushing's disease), GH (acromegaly)
• hormone hyper- or hyposecretion due to compression of the pituitary, hypothalamus or pituitary stalk
• amenorrhoea and/or loss of libido caused by disturbance of FSH, LH, PRL or GnRH secretion

Investigations

Typically an MRI scan, visual field examination and hormone tests.

Objectives of treatment

• Relief of pressure symptoms
• Restoration of appropriate hormone levels
• Prevention of further tumour growth

Treatment options

Surgery

Surgery is the treatment of choice for certain types of pituitary tumours but by no means all. The decision will depend on the size and type of tumour, for example, prolactinomas will almost always be treated by medical therapy rather than surgery. Surgery is usually transsphenoidal (factsheet 9) and involves a 4-5 day in-patient stay. If the tumour is large, other approaches such as subfrontal surgery may be required. Surgical treatment may be followed by other treatments such as Radiotherapy or medical intervention. Removal or reduction of the tumour may result in temporary or permanent damage to the pituitary (hypopituitarism). Diabetes insipidus may also occur after surgery, but this is likely to be transient.

Radiotherapy

Radiotherapy reduces the rate of recurrence of tumours and may be carried out alone or in conjunction with other treatments. Linear accelerator radiotherapy (LINAC) involves delivery of a standard dose at several entry points in order to concentrate the dose in the desired area and avoid damage to surrounding tissues. In some cases, but not all, the principle long-term side effect of radiotherapy is gradual loss of pituitary function, resulting in the need for permanent hormone-replacement therapy.  (See factsheet 10.)

Medical treatment

Drugs such as cabergoline or Bromocriptine are the preferred treatment for prolactinomas and often shrink the tumour as well as decrease hormone secretion. Analogues of Somatostatin can block GH secretion in acromegaly.

Questions patients may ask

Have I got cancer?

No - in this case tumour just means 'lump'. Pituitary tumours only very rarely spread to other parts of the body. Untreated, they may gradually increase in size where they are.

Will I need treatment?

Not necessarily. About one person in ten has a small Pituitary tumour. If discovered accidentally, it may not be necessary to have any treatment at all.

Will it go away when I'm treated?

It is often not possible to remove the tumour entirely. In most cases, however, its growth and activity can be controlled.

Will I have to take tablets in the long-term?

Drugs given to suppress high hormone levels produced by the tumour may not be needed long term if other treatment has been given. If the tumour, or the treatment for it, affects the function of the normal Pituitary gland, then long-term replacement therapy will be necessary - most patients find this readily acceptable.

Will I still be able to have a family?

Yes, if the reason for infertility is pituitary disease. The effects of pituitary tumours on fertility can be treated, although some treatments are not paid for by the NHS (factsheet 11).

Have I inherited this, will my children get it?

In all but very exceptional circumstances there is no hereditary link.