Incidence: 10 New Cases per million per year

Non-Functioning Pituitary Tumours

The most common type of Pituitary tumour is non-functioning (i.e., it  does not produce effects by excessive hormone production). Tumours of this type most commonly become apparent when the patient has visual sympoms or headache due to pressure on the optic nerve and it is often the optician who refers the patient to the GP with abnormal visual fields (in which case the GP would want to refer to an opthalmologist who, in turn, is likely to refer to an Endocrinologist). The tumour may also damage the adjacent, normal Pituitary gland (causing hypopituitarism - factsheet 6) or occasionally compression of the pituitary stalk, causing Hyperprolactinaemia (factsheet 5).

Please see 'Who and When to Refer' (factsheet 14).

Presenting symptoms

• visual disturbance
• Oligomenorrhoea or Amenorrhoea in women
• tiredness and lack of energy
• reduced libido and potency in men
• headache

Investigations

An MRI scan will be carried out to determine the size and site of the tumour. Visual field tests are used to determine the degree of functional impairment of the visual pathway. Blood tests will be needed to assess pituitary function.

Treatment possibilities

In the Absence of Pressure Signs/Symptoms

Patients may not need treatment, but will be monitored closely using MRI scans and visual field checks at intervals of 6 or 12 months. Alternatively surgery or Radiotherapy may be advised.

In the Presence of Pressure Signs/Symptoms

Patients will usually need Transsphenoidal surgery (factsheet 9), which may be followed by radiotherapy to prevent recurrence (factsheet 10). If pituitary hormones are deficient, pituitary hormone replacement therapy will be given (factsheet 11).

Patient management

Post-Operative

Most patients will have improved, or at least stabilised, visual fields. Removal of the nasal packing is often the only part of the procedure that patients find uncomfortable. Some patients may find that their frequency of headaches changes. Other complications, such as CSF leaks can occur, although rarely, and need to be treated by a further small operative procedure (factsheet 9).

Long Term

Regular visual field and acuity assessments will be needed. MRI scans are usually repeated within the first post-operative months and follow-up scans are carried out at increasing intervals from 6 months to 5 years.

Radiotherapy

Pituitary radiotherapy (factsheet 10) may be used after surgery to reduce the risk of re-growth of the tumour. Since radiotherapy can cause hypopituitarism at variable times after treatment, patients should be tested for pituitary function on a regular basis, probably at 6 months, 1 year, 2 years and then bi- or triennially.

Watchpoints

Urgent - refer to hospital

• Deterioration of vision
• Clear fluid dripping down the back of the throat or through the nose soon after surgery (CSF leak - factsheet 9)

Non-urgent (but still very important)

• If the patient is on Hydrocortisone, ensure that replacement therapy is increased when seriously ill or under major physical or psychological stress (factsheet 4)
• Treat headaches and migraine
• Ask about erectile function
• General well-being - consider whether the patient is Growth hormone deficient e.g., if energy lacking, otherwise for replacement therapy
• Menstrual cycle loss - consider whether the patient needs hormone replacement therapy

Resources for patients

Please go to the Resource Library of this website to access resources for patients.  Our library includes literuature, newsletters and articles available from The Pituitary Foundation as well as the contact information for other organisations who provide support and information.  All of our patient leaflets are available to read as well as downloadable in PDF format from this website. 

Resources for GPs