Knowing Your Pituitary Adenoma Care is in the Right Hands

Pituitary adenomas may cause problems because of hormonal hypersecretion, pituitary hormonal failure, vision loss, headaches and/or bleeding into the tumor (apoplexy).

Hormonal hypersecretion

The three most common hormonally active adenomas are prolactinomas, GH-secreting tumors causing acromegaly, and ACTH-secreting tumors causing Cushing’s disease. Thyroid stimulating hormone (TSH) tumors are relatively rare.

Pituitary hormonal deficiency (Hypopitutiarism)

(Hypopituitarism) This problem typically occurs only in larger tumors (macroadenomas) and results from compression and damage to the normal pituitary gland from the enlarging adenoma.

Manifestations may include:

• Hypogonadism – sexual dysfunction, loss of libido, and impotence
• Hypothyroidism – fatigue, weakness, weight gain, coarse dry hair and dry skin, cold intolerance, depression
• Adrenal insufficiency – fatigue, weakness, loss of appetite, dizziness, nausea and vomiting
• Growth failure – in children and adolescents
• Hyperprolactinemia – due to “stalk effect”. This is seen in diseases within or near the pituitary gland and stalk. Interfering with the delivery of dopamine, a neuron-transmitter, from the hypothalamus to the prolactin secreting cells of the pituitary gland), which can result in hypogonadism and its associated problems. Rarely posterior pituitary gland damage occurs with diabetes insipidus, which is caused by the inability of the kidneys to conserve water, leading to frequent urination and thirst. 

Neurological problems

Larger pituitary macroadenomas often cause loss of visual acuity or peripheral vision (termed bitemporal hemianopsia) from pressure on the optic nerves and optic chiasm which is directly above the pituitary gland. Larger macroadenomas especially those that have hemorrhaged (apoplexy) may also cause double vision.

Headache

Patients with macroadenomas often have frontal, forehead and temporal area headaches. Pituitary adenoma removal often results in headache resolution.

Bleeding (pituitary apoplexy)

This condition develops over hours to several days from hemorrhage and/or infarction of pituitary adenoma (typically a macroadenoma or a Rathke’s cleft cyst).

Symptoms may include:

• Headache
• Nausea
• Visual loss
• Double vision
• Confusion

Most patients have undiagnosed hormone insufficiency prior to the apoplectic event. Pituitary apoplexy is best confirmed by MRI. A head CT will also show areas of bleeding or a mass in the sella in the majority of cases. Other conditions that can mimic pituitary apoplexy are a ruptured aneurysm, meningitis, a stroke, intracerebral hemorrhage and migraine headache.

The treatment for most patients with pituitary apoplexy is urgent endoscopic endonasal surgery and intravenous administration of the stress hormone cortisol.