Pituitary tumors

Overview

Pituitary tumors are not brain tumors. Pituitary tumors grow in the pea-sized pituitary gland, just under the brain.

The great majority of pituitary tumors are cancer-free, but they can still cause problems. That’s because the gland controls the endocrine system, and tumors often cause it to produce too many or too few hormones. That can lead to a dozen different disorders, tied to metabolism, mood, sexuality, reproduction and other body functions. Tumors can also squeeze the nerves controlling vision.

Our approach

Despite their location near the brain, pituitary tumors are highly treatable — especially in the right hands. The physicians at Northwell Health have the diagnostic expertise to recognize the disease when others may not, and the experience to know which approach to take: from “watchful waiting” to surgery.

If diagnosed early enough, the prognosis for recovering from a pituitary tumor is excellent. But the disease can impact a dozen different hormones and related disorders with a broad spectrum of symptoms — often obscuring the culprit for those not experienced with the warning signs.

Northwell Health doctors know when to follow their suspicions. They’re skilled with the complicated, sensitive tests required to look for hormones in the blood, urine or saliva — a tell-tale red flag. They’re also experienced with drawing the distinction between hormonal and neurological symptoms, a challenge because of the pituitary gland’s location near the brain.

The neurosurgeons helped refine the use of special surgical tools to give them a better view during minimally invasive surgery. They also have the most experience in the country using special, open MRIs during operations — freeing patients from restrictive scanners but giving physicians a continuously updated picture as they carefully navigate the delicate structures around the brain.

Team Approach to Pituitary Gland Tumors

The neurosurgeons pioneered several of the surgeries to remove pituitary tumors. They oversee patient care and are joined by a multidisciplinary team of other specialized physicians, all of whom have experience successfully caring for the pituitary gland tumors and related problems. The team works closely to coordinate patient care.

Risk factors

There are three rare, inherited disorders that increase the chances of developing a pituitary tumor. Genetic testing is available for these conditions, which include:

  • Multiple Endocrine Neoplasia Type 1 (MEN1) - causes the pituitary gland to become overactive
  • Carney Complex - also changes the skin color
  • Familial Acromegaly - causes the production of too much growth hormone

Symptoms

Sometimes pituitary tumors haven’t been causing any problems and are discovered during a scan for another medical issue. But in other cases they can prompt the gland to produce too many hormones, press on the gland and slow hormone production, or squeeze the nearby nerve (optic) controlling eye movement.

There are more than a dozen different disorders that can result from pituitary tumors and disease, with symptoms that can include:

  • Headaches
  • Vision problems
  • Menstrual cycle changes
  • Impotence
  • Infertility
  • Unusual breast milk production (galactorrhea)
  • Easy bruising
  • Aching Joints
  • Muscle Weakness
  • Cushing’s syndrome (combination of weight gain, high blood pressure, diabetes and easy bruising)
  • Acromegaly (enlargement of the extremities or limbs and thickening of the skull and jaw)
  • Fatigue
  • Mood changes
  • Irritability
  • Osteoporosis (bones becoming more fragile)
  • Obesity
  • Carpal tunnel syndrome

Having three or more of these symptoms may mean someone has a pituitary tumor, though there are other causes for these problems, too. See a doctor to determine the source of symptoms. 

Types

There are three types of pituitary tumors:

  • Benign pituitary adenomas - These non-cancerous tumors grow slowly and do not spread.
  • Invasive pituitary adenomas - Though non-cancerous, these tumors may still spread to the skull or sinus cavity
  • Pituitary carcinomas - Rare, malignant (cancerous) tumors that can spread, including into the central nervous system

The tumors can develop in each of the pituitary’s lobes, potentially disturbing a different set of hormones:

  • Anterior Lobe
    • Growth Hormone - Promotes growth of certain arm and leg bones, and thickens the skull and spine
    • Prolactin - Stimulates milk production after giving birth
    • ACTH (adrenocorticotropic hormone) - Controls adrenal gland hormones connected to blood pressure, metabolism and stress response
    • TSH (thyroid-stimulating hormone) - Stimulates the thyroid gland, which regulates metabolism
    • Gonadotropins (follicle stimulating hormone, or FSH, and luteinizing hormone, or LH) - Stimulate production of sperm or eggs and regulate the menstrual cycle
    • Lipotropin - Stimulates the movement of body fat to the bloodstream
  • Intermediate Lobe
    • Melanocyte-Stimulating Hormone - Controls skin pigmentation
  • Posterior Lobe
    • ADH (antidiuretic hormone) - Makes kidneys absorb more water
    • Oxytocin - Contracts the uterus during childbirth and stimulates milk production

Given the wide range of symptoms, pituitary tumors are not always suspected as the cause and may go undetected. That’s why it’s important to see a medical team that knows what to look for. 

Diagnosis

A doctor will use diagnostic tests to determine whether the patient has a tumor, and if so, whether the tumor is causing problems with hormonal levels, or has spread to nearby areas like the sinuses. Tests could include:

  • Physical exam
  • Blood, Urine and Saliva Tests - The doctor tests hormone levels in the blood, and possibly in the saliva and urine.
  • Vision Test
  • Neurological Exam - The doctor examines the central nervous system, including reflexes, motor and sensory skills, balance and coordination, and mental state.
  • MRI (Magnetic Resonance Imaging) - A radiologist uses a magnet, radio waves and a computer to take detailed pictures of the inside of the body, sometimes injecting a contrast dye to create a clearer picture.
  • Biopsy - The doctor removes cells or tissue, and then a pathologist checks the sample for cancer and hormone production.

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