Pituitary Tumor Treatment

Pituitary Tumor Treatment Options​

Therapy of a pituitary tumor depends on factors like the size, type, hormone level, signs and risk of the patient. The main treatment options include:

Medications

• Used for hormone-secreting pituitary tumors.
• It is effective in helping to decrease the size of the tumor as well as managing the hormone levels.

Surgery

• Often used for big masses or if drug interventions are not a possibility.
• Transsphenoidal Surgery (through the nose) – Minimally invasive and most common.
• Craniotomy (through the skull) – Used for larger or complex tumors.

Radiation Therapy

• Used when the surgery is not applicable or if the tumor persists even after the surgical process.
• Stereotactic radiosurgery – Gamma Knife, CyberKnife – very high concentrated radiation.
• External beam radiation – Given over multiple sessions.

Hormone Replacement Therapy

If the tumor or treatment affects the pituitary hormone, then one will require thyroid, adrenal or reproductive hormones.

Pituitary Adenoma Surgery​

Surgery as treatment of pituitary adenomas remains the first line of management especially if the tumors are large and causing pressure on the surrounding tissues such as the optic nerves or if they are unresponsive to drugs.

Types of Pituitary Adenoma Surgery

• Transsphenoidal Surgery (Endoscopic or Microscopic)
• Most common and preferred method.
• Minimally invasive approach through the nose and sphenoid sinus.
• Endoscopic transsphenoidal surgery in which a small camera is used to have a clear vision.
• Microscopic transsphenoidal surgery employs the use of microscope in the operation procedure.

Advantages:

• No external incision (faster healing).
• Lower risk of complications.
• Shorter hospital stay (usually 1–2 days).

Craniotomy (Transcranial Surgery)

• Complicated cases which cannot be handled through endoscopic method since the tumor is relatively big and it blocks a large part of the nasal cavity.
• It involves bringing the skull’s opening in order to access the tumor.

Advantages:

• Effective for large, invasive adenomas.
• Facilitates a better approach if the tumor has invaded other parts of the brain than the pituitary gland.

Disadvantages:

• Longer recovery time.
• Higher risk of complications.

Non-Surgical Treatment for Pituitary Tumors

If surgery cannot be done or if the tumor is small and not painful, then some other treatments can be given. Treatment option depends on the state whether the tumor is functioning or non-functioning together with its size and functions.

Medications (For Hormone-Secreting Tumors)

Some of the pituitary tumors secrete hormones in abundance and they are usually managed by medications:

Prolactin-Secreting Tumors (Prolactinomas)

• Dopamine agonists (e.g., Cabergoline, Bromocriptine)
• These drugs can shrink the size of tumor in the breast and accordingly decrease the levels of prolactin in the blood.
• At other times, long-term use of medication can bring about total cure of the illness.

Growth Hormone-Secreting Tumors (Acromegaly)

• Bromocriptine – Dopamine antagonist which works specifically on the pituitary gland, useful in suppressing growth hormone production.
• Somatostatin analogues (e.g., Octreotide) – inhibit growth hormone release and decrease its effects.

ACTH-Secreting Tumors (Cushing’s Disease)

• Steroidogenesis inhibitors (Ketoconazole, Metyrapone, Osilodrostat) – inhibit cortisol biosynthesis.
• Somatostatin analogs such as Pasireotide – act to suppress ACTH secretion.

Thyroid-Stimulating Hormone (TSH)-Secreting Tumors

• Somatostatin analogs may be used to reduce the levels of thyroid hormones secretion when levels are too high.

Radiation Therapy (For Tumors Not Fully Treated by Medication)

Radiotherapy can decrease size of tumors and its progress when the surgical intervention is impossible.

Stereotactic Radiosurgery (Gamma Knife, CyberKnife)

• Essentially, radiation beams of high accuracy pertain to the identified tumor area.
• Minimally invasive, often done in one session.
• Applied in such conditions as small tumor or when a tumor has been left behind after surgery.

Conventional Radiation Therapy

• Delivered over several weeks.
• Applied for tumors that occupy a bigger area of the brain and cannot therefore be removed through stereotactic radiosurgery.

Hormone Replacement Therapy

When the tumour has an effect on normal pituitary function, they need hormone replacement for:

• Cortisol (Hydrocortisone, Prednisone) – in case of low cortisol production.
• Thyroid hormone (Levothyroxine) – for underactive thyroid.
• Hormones – growth hormone – only if deficiency is proved.

Radiation Therapy for Pituitary Tumors​

Radiation therapy is applied in the treatment of pituitary tumor in the following circumstances:

• If surgery was not possible or if it was done, it was not effective.
• The tumor recurs after treatment.
• Hormone levels are not being regulated by medications as it should be.

Types of Radiation Therapy for Pituitary Tumors

Stereotactic Radiosurgery (SRS)

• Examples: Gamma Knife, CyberKnife, LINAC-based systems.
• Aims at providing a single large dose of radiation to the tumor only.
• Minimally invasive (no incisions).
• Recommended for: Tumors that are small or any residual tumor mass that may be present after surgery.

Advantages:

• Maximum accuracy with least invasion of other parts of the brain.
• Normally takes only one session with the patient.
• Less likelihood of deleterious effects on the healthy pituitary gland as compared to what is observed in conventional radiation therapies.

Fractionated Stereotactic Radiotherapy (FSRT)

• Similar to SRS but it is given in small doses daily or weekly rather than one large fraction over days or weeks.
• Contributes to lowering of damage to the pituitary gland or lends to its protection.
• Best for: Larger tumors or those close to sensitive areas (e.g., optic nerves).

Conventional External Beam Radiation Therapy (EBRT)

• It is administered as multiple sessions which may last for weeks starting from 4 or 6 daily sessions depending on the intensity of radiation.

Best for:

• Malignant pituitary tumours that cannot be excised fully.
• Tumors that do not grow rapidly and would therefore need long-term regulation.

Disadvantages:

• Takes longer to reveal its effectiveness; the shrinking of the tumor usually occurs in months or years.
• Higher risk of long-term damage to normal pituitary function.

Endoscopic Endonasal Surgery for Pituitary Tumors​

Endoscopic endonasal surgery is an innovative technique that consist in removing pituitary tumors through the nasal cavity. Transsphenoidal surgery is the recommended surgical approach for most tumour of the pituitary gland.

Access through the Nose

• Some of these are thin tubes with a camera which is inserted through the nostril into the sphenoid sinus – a hollow space behind the nose.
• No external incisions are needed.

Tumor Removal

• Pituitary tumors are reached though the nostril and the normal tissue of the pituitary gland is left intact.
• A neurosurgeon and an otolaryngologist collaborate with each other.

Closure & Recovery

• Cerebrospinal fluid leakage is also addressed through the use of tissue, or surgical glue to cover the surgery area.There is no scar to be seen afterwards and the hospitalization averages one to two days at the most.

Recovery after Pituitary Tumor Surgery​

The period of rehabilitation after removal of the pituitary tumor depends with the extent of surgery, the size and position of the tumour besides the overall health status of a patient. The most frequent technique is transsphenoidal and endonasal surgery and in general, it is faster to recover than with craniotomy.

Immediate Post-Surgery Recovery

Hospital Stay:

Endoscopic Endonasal Surgery: 1–3 days

Craniotomy (Transcranial Surgery): 3–7 days

Risks of Pituitary Tumor Surgery​

Pituitary tumor surgery carries certain risks depending on its size, location, and type of the tumor and the surgical procedure used. Though the risks presented may be short lived or permanent depending on the patient.

• Hormonal Imbalances
• Cerebrospinal Fluid Leak
• Vision Changes
• Infection & Meningitis
• Bleeding & Stroke
• Incomplete Tumor Removal & Recurrence
• Nasal Congestion & Breathing Issues

Pituitary Tumor Symptoms and Treatment​

Pituitary tumors are growths on pituitary gland which is a small endocrine gland located at the base of the brain that secretes hormones. Mainly Pituitary tumours are adenomas and the majority of them are benign tumours yet, they can become problematic in a number of ways.

Symptoms of Pituitary Tumors

Symptoms depend on tumor type, size, and hormone production.

Symptoms Due to Tumor Growth (Pressure on Nearby Structures)

• Headaches (persistent or worsening).
• Blurring of vision, occurrence of double vision or peripheral vision loss.
• Preoperative nausea or vomiting (if the brain pressure due to the frontal tumor).
• Fatigue and dizziness.

Symptoms Due to Hormonal Imbalances

A) Hormone-Secreting Tumors (Overproduction of Hormones)

• Irregular or missed periods, infertility (women).
• Erectile dysfunction, low libido (men).
• Unexplained breast milk production (galactorrhea).
• Enlarged hands and feet as well as facial features.
• Joint pain, excessive sweating.
• Weight gain (especially in the face and upper body).
• High blood pressure, diabetes, thin skin, easy bruising.
• Hyperthyroidism (rapid heartbeat, weight loss, nervousness).

B) Pituitary Hormone Deficiency (Underproduction of Hormones)

• Fatigue & Weakness (low thyroid or adrenal hormones).
• Infertility & Low Sex Drive (low estrogen/testosterone).
• Unexplained Weight Gain or Loss.

Hormone Therapy for Pituitary Tumors​

• Hormone therapy can be applied as follows to pituitary tumours:
• Surgery may involve blocking of hormone production by removing the part of the body which is responsible for hormone production in case of hormone-secreting tumors.
• In cases where the tumor or treatment has impacted the normal secretion ability of the pituitary gland, it will usually be prescribed by a doctor to supplement the body with the missing hormones.

Best Hospitals for Pituitary Tumor Treatment​

Medanta-The Medicity, Gurgaon

Medanta - The Medicity, a renowned multi-specialty hospital in Gurugram, India, offers comprehensive care for pituitary tumors. Some of the special operations that the hospital embraces includes craniotomy surgery, neuroendoscopy, MRI assisted laser ablation and neuroplastic surgery operations. For the malignant tumors that are not operable, the options available at Medanta include external beam radiotherapy and stereotactic radiosurgery and advanced technology known as CyberKnife. They also get a counselling, rehabilitation, and support group that makes them get well soon. Medanta recognizes technology as a resource in organizing high-quality medical care for people with pituitary tumour.

Artemis Hospital, Gurgaon

Artemis Hospital located at Gurgaon is equipped with specialized division of Neuroradiology & Neurosurgery, which carries out pituitary tumor treatment. Special techniques such as neuroendoscopy and stereotactic neurosurgery are employed while the hospital avails itself in the most modern equipment like the CyberKnife system in giving radiation therapy. Furthermore, the hospital also offers well-coordinated cancer treatment programmes which involve medical, surgical and radiation therapy treatment in tackling pituitary tumours among other services.

Fortis Memorial Research Institute, Gurgaon

The multi-specialty hospital that provides adequate treatment for pituitary tumors is Fortis Memorial Research Institute (FMRI) located in Gurugram. The hospital embraces the use of modern equipment, and competent professionals in handling patients. These are Gamma Knife Esprit technology that is used in tumor treatment in the brains and Da vinci as well as MAKO; robotic surgery systems. This commitment to blend technology with medical expertise makes FMRI one of the best health facilities that specialize in the treatment of pituitary tumors.