Pituitary tumours are uncommon with an incidence of between 20-30 per million per year, but they do account for 10% of all clinically significant intra-cranial tumours. They can be broadly divided into those that are "functioning" or producing a known hormone or "non-functioning" tumours which do not produce any active hormone and mainly produce symptoms by impinging on surrounding tissues. Because of the rarity of these tumours, patients will generally be referred to a hospital specialist and may then be referred on to a regional centre where multi-speciality expertise in managing these tumours with a neurosurgeon and appropriate radiotherapists are also available.

Management of these cases invariably involves endocrine assessment to assess the presence of hypopituitism or of excess hormones secreted by the tumour. The patient may also require treatment for hypopituitism with appropriate hormone replacement to suppress excess hormone as in the case of prolactinoma's, acromegaly etc. This is usually carried out by a specialist in hormones an endocrinologist. Pituitary tumours often impinge upon nerves that connect the eyes to the brain, detailed assessment of the visual field will also be carried out. MRI scan will also be performed to determine the size and extent of the tumour.

The treatment depends on the presence of symptoms or signs. It is appropriate to simply follow-up with serial MRI scans. In patient's in whom the tumour is causing symptoms, surgery is usually the main modality of treatment with peri-operative hormonal treatment undertaken in consultation with an endocrinologist. In the case of prolactinomas, even where the tumour is large, significant tumour shrinkage can be achieved using medical therapy alone and in these cases, surgery may not be required. Pituitary surgery is often carried out through a sinus that is located behind the nose and can be done through one of the nostrils. In some cases, it is necessary to do a craniotomy ie through the skull.

Patient's can expect a significant improvement in vision after the operation and headache is relieved in nearly all patients. The operation can sometimes be complicated by diabetes insipidus which may be permanent in about 5% of patients. Complications include leak of CSF and meningitis but they occur in less than 10% of patients.

Patients will require long-term follow-up, usually carried out by an endocrinologist to determine appropriate hormone replacement to look for any evidence of tumour recurrence.

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