Pituitary Tumour

Symptoms and red flags

The symptoms depend on the type. A prolactin-producing tumour in a woman causes missed periods, milky discharge from the breasts, difficulty conceiving and sometimes headache; in a man it causes low sex drive and tiredness. A growth hormone tumour slowly enlarges the hands, feet, jaw and brow, so rings stop fitting and the face changes in old photographs. A tumour that drives the adrenal glands causes weight gain around the face and trunk, thin skin that bruises easily, high blood pressure and high blood sugar.

Non-functioning tumours announce themselves differently. The classic sign is loss of the outer edges of vision in both eyes, so the patient starts bumping into door frames. Tiredness, sensitivity to cold, low mood and loss of interest in sex can mean the normal gland is being squeezed. A sudden severe headache with sudden loss of vision or double vision is an emergency, because it can mean bleeding into the tumour, and the patient should reach a hospital at once.

Causes and who gets it

In almost every case there is no known cause. Pituitary adenomas arise from a single gland cell that starts dividing on its own, and nothing the patient did brought it on. They are not caused by injury or by stress. A small number of families carry an inherited tendency to develop them along with tumours of other glands.

They occur in men and women at any adult age. Prolactin tumours are found most often in younger women because a change in periods brings them to a doctor early, while men and older patients tend to present later with vision problems because their hormone symptoms are quieter.

How it is diagnosed

Two tests give most of the answer. An MRI of the pituitary with contrast shows the size of the tumour, whether it is pushing up against the nerves of sight and whether it has grown sideways into the spaces beside the gland that carry major blood vessels. The MRI is the test the decision is made on.

Blood tests measure the pituitary hormones and the hormones of the glands it controls: prolactin, cortisol, thyroid hormone, growth hormone and the sex hormones. They show whether the tumour is over-producing anything and whether the normal gland has been damaged. A visual field test by an eye specialist maps how much side vision has been lost and is repeated after treatment to document recovery. These results are best reviewed with an endocrinologist's input, because hormone balance before and after surgery is a large part of a good result. Growths elsewhere in the head are a separate subject, covered on the brain tumour page.

Treatment: medicine for some types, surgery for others

Not every pituitary tumour needs an operation. Prolactin-producing tumours are the big exception: tablets that switch off prolactin shrink most of them and bring the periods back, so surgery is kept for the few that do not respond to the medicine or cannot tolerate it. Small non-functioning tumours that are not touching the nerves of sight are often simply watched with a repeat MRI.

Surgery is advised when a tumour is pressing on the nerves of sight, when it is making growth hormone or adrenal hormone, when it is growing on serial scans, or when the hormone output is doing harm that tablets cannot control. The operation is done through the nose. A thin camera, the endoscope, is passed along the nostril to the back of the nasal cavity, the thin bone in front of the gland is opened, and the tumour is removed with fine instruments. There is no cut on the face and no opening of the skull, so there is no visible scar. Dr. Salman Falak describes the technique, the hospital stay, the preparation and the follow-up on the endoscopic pituitary tumour surgery page. Radiotherapy is sometimes added later for a tumour that cannot be fully removed.

What recovery looks like

After endoscopic surgery most patients are up and walking the next day and go home within a few days. The nose feels blocked and crusty for some weeks, and a little bloodstained discharge is expected. Blowing the nose hard and heavy straining are avoided for a few weeks to protect the repair at the back of the nose.

Vision, when it was affected, often begins improving within days because the pressure on the nerves is gone, though the final result takes months. Hormone levels are checked closely in the first weeks. Some patients pass a lot of urine for a few days as the water balance resets, and some need hormone tablets for a while or, in a minority, long term. A follow-up MRI a few months after surgery shows how much was removed. Patients from other cities have the blood tests done near home and reviewed by video.

When to see a neurosurgeon

Anyone told by an eye specialist that the outer field of vision is shrinking in both eyes should see a neurosurgeon soon. The same applies to anyone whose MRI report mentions a pituitary lesion or a sellar mass. Women with unexplained missed periods and milky discharge, and men with unexplained loss of sex drive, should first have a prolactin blood test, because that one test often gives the answer.

For patients in Faisalabad, Gujranwala, Sahiwal and other cities, the first step is a video consultation with the MRI and hormone reports sent ahead on WhatsApp. Dr. Salman Falak can then say what the tumour needs, and the journey to Lahore is made only when there is a clear plan.

Related procedures and pages

The main operation for this condition is endoscopic pituitary tumour surgery, linked above. It is part of the brain surgery Dr. Salman Falak provides in Lahore, alongside surgery for other brain tumours and for trigeminal neuralgia. Patients in Gujranwala can be seen at the Friday OPD at Gujranwala Medical Complex before any trip to Lahore, and those near Phool Nagar on Tuesdays.