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Treatment for pituitary tumours

The pituitary gland is a small gland on the underside of the brain. Most pituitary gland tumours are pituitary adenomas, which are benign (non cancerous) slowly growing tumours that start in pituitary tissue cells. Some pituitary adenomas produce hormones and are called secretory tumours. Others do not produce hormones and are called non secretory tumours. The treatment depends on whether your tumour produces hormones or not.

Adenomas that don't produce hormones

Non secretory tumours are usually larger than the hormone producing tumours. They can press on the optic nerves and cause changes in your eyesight. They may also affect the normal pituitary gland tissue so that you have lower levels of some hormones. 

If the tumour is large you usually have surgery to remove as much of the tumour as possible. The surgery is carried out using a thin tube passed up the nose and is called endoscopic transphenoidal resection. Any tumour left behind is treated with radiotherapy. With this treatment these tumours are nearly all controlled and very few grow again after treatment.

Hormone producing adenomas

There are several different types of secretory tumours and they produce different types of hormones. Prolactinomas cause milk production by the breasts, infertility and loss of sex drive. They are usually treated with tablets that reduce prolactin production by the tumour. Other types of tumours produce steroids, growth hormone or thyroid stimulating hormone. These tumours should be completely removed if at all possible, using endoscopic transphenoidal resection. 

If your hormone levels are still raised in your blood after surgery, your doctor will normally advise that you have radiotherapy to the remaining tumour. 

After effects of radiotherapy 

Some years after radiotherapy to the pituitary gland, you may develop low levels of pituitary hormones. If this happens, you will need to take replacement hormones for the rest of your life.

 

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What pituitary tumours are

The pituitary gland is a small gland on the underside of the brain. It is marked in yellow on the diagram.

Diagram showing the parts of the brain

Most pituitary tumours are pituitary adenomas, which are benign (non cancerous), slowly growing tumours that start in pituitary tissue cells. They can be microadenomas which are small tumours, less then 1cm in size. Or they can be macroadenomas, which are larger than 1cm. 

Some pituitary adenomas produce hormones and are called secretory tumours. Others do not produce hormones and are called non secretory tumours. 

The treatment depends on whether your tumour produces hormones or not. 

 

Your treatment team

Your care and treatment will be managed by a team specialising in the treatment of pituitary tumours. This will include

  • An endocrinologist (a specialist in hormone system diseases)
  • A neurosurgeon (a specialist in brain surgery)
  • A neuro oncologist (a specialist in radiotherapy for tumours in the brain)
  • A specialist nurse
 

Adenomas that don't produce hormones

Non secretory tumours are usually larger than the hormone producing tumours. They can press on the optic nerves and cause changes in your eyesight. They may also affect the normal pituitary gland tissue so that you have lower levels of some hormones.

The treatment is usually surgery to remove as much of the tumour as possible. The surgery is carried out using a thin tube passed up the nose and is called endoscopic transphenoidal resection

Any tumour left behind after surgery is treated with external radiotherapy for 5 weeks, or possibly a very precisely targeted type of radiotherapy called radiosurgery. Radiotherapy is very good at controlling these tumours and more than 9 out of 10 (90%) show no growth after 10 years.

With this treatment these tumours are nearly all controlled and very few grow again after treatment.

 

Hormone producing adenomas

There are  several different types of secretory tumours

  • Prolactinomas, which cause milk production by the breasts, infertility and loss of sex drive
  • Steroid producing tumours, which cause Cushing’s syndrome (weight gain on the trunk of the body, a moon face, acne, mood swings, diabetes, and high blood pressure)
  • Growth hormone producing tumours, which cause excess height in young people or acromegaly in adults (overgrowth of hands, feet, lower jaw and brows)
  • Thyroid stimulating hormone producing tumours, which cause an overactive thyroid gland leading to weight loss, feeling hot, irregular periods, moods swings, and an irregular heart beat

Prolactinomas

Prolactinomas are usually treated with tablets that reduce prolactin production by the tumour. Drugs that may be used include cabergoline (Dostinex) and quinagolide (Norprolac). Women who want to have a baby are usually treated with a drug called bromocriptine (Parlodel).

Other types of hormone producing tumours

Treatments for other types of hormone producing tumour may include

Surgery

The tumour should be completely removed if at all possible. This can cure many people. The surgeon uses a thin tube passed up the nose to remove the tumour (endoscopic transphenoidal resection). So there is no external scar.

Radiotherapy

You might have radiotherapy to the tumour if your hormone levels are still raised in your blood after surgery. This may be conventional external radiotherapy for 5 weeks, or stereotactic radiotherapy or radiosurgery. But radiotherapy takes quite a long time to work to lower the hormone levels. It may take some months before your hormone levels get back to normal. 

Hormone blocking medicines

While waiting for the radiotherapy treatment to work you need to take medicines to block the hormone production. For example you may need to take lanreotide or octreotide if you have acromegaly. 

 

After effects of radiotherapy

Years after radiotherapy to the pituitary gland, you may develop low levels of all the pituitary hormones. This is because the radiotherapy can damage healthy pituitary tissue. But this can take a long time to happen. Your endocrinology specialist will monitor your hormone levels with blood tests every year or so. If you have low levels of pituitary hormones, you will need to take replacement hormones for the rest of your life.

 

If a pituitary tumour comes back

Very occasionally pituitary adenomas come back or start to grow again after surgery and radiotherapy. In this situation you usually have more surgery to remove the tumour. Some early studies have suggested that temozolomide chemotherapy can help to control the tumour for some people.

 

More information about pituitary tumour treatment

If you would like more information about treatment for tumours in the pituitary gland you may find it in our section about brain tumour treatment.

You can find information about the outlook (prognosis) for these tumours on the brain tumour statistics and outlook page

You are also welcome to contact the Cancer Research UK nurses on freephone 0808 800 4040. Lines are open from 9am to 5pm, Monday to Friday. 

You can contact one of the brain tumour organisations or look at our brain tumour reading list. If you want to find people to share experiences with online, you could use CancerChat, our online forum.

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Updated: 13 December 2013