Adults · Conditions
Pituitary adenoma
A usually benign tumour of the pituitary gland, which may affect hormones or vision. Treatment may include medication, surgery or Gamma Knife radiosurgery.
What is it?
A pituitary adenoma (also called a pituitary neuroendocrine tumour) is a usually benign growth of the pituitary gland, at the base of the brain behind the eyes. Some produce excess hormones (functioning adenomas), such as prolactin, growth hormone or ACTH; others do not (non-functioning adenomas) but can grow large enough to press on the nerves to the eyes.
What symptoms can it cause?
Symptoms depend on the type. Hormone-producing tumours may cause irregular periods or milk discharge, reduced libido, changes in hands, feet and facial features (acromegaly), or weight gain, high blood pressure and skin changes (Cushing's disease). Larger tumours may cause headaches, loss of side vision, or reduced pituitary function with tiredness. Rarely, sudden bleeding into the tumour (pituitary apoplexy) causes a severe headache and vision loss, which is an emergency.
How is it assessed?
An MRI scan of the pituitary, blood tests of hormone levels, and formal eye and visual field testing. Your care is planned with endocrinologists, the ENT surgeon who operates jointly with Dr Labuschagne, ophthalmologists and radiation oncologists.
What are the treatment options?
Options include:
• Monitoring for small, non-functioning adenomas.
• Medication, the usual first treatment for prolactin-producing tumours (prolactinomas).
• Surgery, usually through the nose (transsphenoidal surgery, often endoscopic), performed together with an ear, nose and throat (ENT) surgeon.
• Gamma Knife radiosurgery, a focused, single-session form of radiation treatment without an incision, used for selected tumours, particularly tumour that remains or regrows after surgery. Dr Labuschagne serves on the executive committee (EXCO) of Gamma Knife South Africa.
• Conventional radiotherapy in some cases.
When might surgery be considered?
Surgery may be advised when a tumour presses on the nerves to the eyes, produces excess hormone (other than most prolactinomas), is growing, or for pituitary apoplexy.
What to expect from recovery and follow-up
After transsphenoidal surgery most people stay in hospital for a few days. Nasal congestion is common for a few weeks. Hormone levels and fluid balance are monitored closely, and some people need hormone replacement. Long-term follow-up with the endocrinology team and MRI scans is important. After Gamma Knife treatment, the effect develops over months to years, and pituitary function is checked regularly.
When to seek urgent help
If you have a sudden severe headache, a seizure, new weakness, confusion, difficulty speaking, or loss of bladder or bowel control, go to the nearest emergency unit or call 10177. If you are under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600). Sudden severe headache with vision loss, or (if you take hydrocortisone) vomiting or feeling very unwell, needs urgent assessment.
This page is general information. Your doctor will advise on what applies to you.