Treatment for Pituitary Conditions

The treatment is based upon the behavior of the pituitary gland. If it is overproducing a chemical called prolactin, then it will be treated, in most cases, with an oral medication which can reduce the over secretion of this hormone and often shrink the tumor as well. If the tumor is secreting growth hormone or another hormone called ACTH, then the gland will be treated surgically. In some cases, where surgery is postponed, additional treatment with radiotherapy is often used as additional therapy. Often no therapy is proscribed for tumors that are not over secreting any hormones and are not otherwise causing vision problems. In the event that surgery becomes necessary, it is extremely important that surgery be performed by an experienced pituitary neurosurgeon, as surgical results are dependent upon the skill and experience of the surgeon. Medication may be required to replace the hormones which are deficient. This may include cortisone to replace inadequate adrenal function, thyroid hormone, and sex hormones (estrogen and progesterone for women, testosterone for men). Growth hormone is necessary to restore appropriate growth in children. Growth hormone deficiency in adults may be associated with symptoms of fatigue as well as abnormal weight gain and osteoporosis (thinning of the bones). Its use in adults should be discussed in detail with your endocrinologist.

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Generally pituitary tumors are removed by an operation called a trans-sphenoidal hypophysectomy. The pituitary gland is reached by a surgical incision on the inside of the lip or nose that is not visible after healing. The surgeon then proceeds through the sinus cavity to reach the tumor. Complications of pituitary surgery are rare and include loss of normal pituitary function (including water balance control), and rarely infection, bleeding, or leakage of fluid from inside the brain cavity (spinal fluid). Your endocrinologist will discuss with you the surgical team in your area which is best equipped to handle your care. If you live in an area without such a team, referral to a center with experience in pituitary surgery is advised. Radiation therapy for the pituitary may take various forms including cobalt radiation or new highly focused high-energy radiation treatment called gamma knife therapy or conformational radiotherapy used at a few centers with specialized expertise. Although all of the radiation used for pituitary radiation are safe and usually not associated with serious side effects, your endocrinologist and radiotherapist will discuss with you the specific indications, benefits and risks of your particular situation.
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