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The pituitary gland produces (secretes) many hormones that stimulate glands in the body to produce other hormones or to complete certain actions. Various treatment options for dealing with pituitary tumors are explored.
Several types of medical therapy can help to relieve pituitary problems. Prolactinomas, for example, respond well to a dopamine agonist drug. If surgery does not remove the entire tumor, sometimes octreotide is used in patients with acromegaly or TSH-secreting tumors. Medication is used to lower high hormone levels or to shrink the tumor. Sometimes pegvisomant may be used to block the action of growth hormone. In many cases, medical therapy is combined with surgery and/or radiation treatment.
Hormone replacement therapy is an important part of any treatment for a pituitary disorder. Hormones must be prescribed to meet your exact needs. Sometimes tumors cause a lack of hormone, which can lead to the symptoms you are having. Sometimes lack of hormone is caused by the treatment you have for pituitary tumors. Radiation therapy, for example, can lead to permanent loss of hormone secretion.
Some hormones are absolutely necessary for survival. These hormones must be replaced immediately. The replacement of cortisol is important, because this hormone regulates blood pressure and blood glucose levels. Cortisol replacement is common during tumor surgeries because it helps the body to handle stress.
TSH, or thyroid stimulating hormone, is also vital to survival, because it regulates the body's metabolism. If TSH secretion is low, you may also need to start thyroid hormone replacement.
ADH (vasopressin) needs immediate replacement, because it controls the body's water balance. If it is missing, this can cause excess thirst and urination, which is usually a temporary condition. (Note: This is not the same as diabetes mellitus, a common confusion.)
Other hormones, such as estrogen and progesterone in women and testosterone in men also may need to be replaced. While they are not vital for survival, they help you to live a full and healthy life. In addition to reproductive effects, these hormones are important for many function such as maintaining normal bone mass. It is important to remember that hormone replacement of estrogen and progesterone in young women, i.e., replacing hormones back to where they would be if the pituitary works, is not the same as post-menopausal hormone replacement. In the latter case, hormones are being given at a time in life when they are not normally made.
Some hormones may return to normal levels after treatment for a pituitary condition. In other cases, there may be some permanent loss of hormone function. You may need to take certain hormones for the rest of your life. Your doctor will work with you to monitor and adjust your hormone replacement therapy as needed. You should always take your hormone treatment as directed.
The most common form of surgery to remove pituitary tumors is transsphenoidal microsurgery. A neurosurgeon approaches the pituitary tumor through the nose, in the sphenoid sinus cavity. Using this natural pathway the surgeon does not need to drill a hole in your skull. With a surgical microscope and special instruments, the surgeon can typically safely remove the tumor without damaging the surrounding pituitary gland.
This surgery is not very painful, and you won't have any outer scars. You may have a sore nose or what feels like a sinus headache. Most patients are only in the hospital for one night. You should take it easy for a few weeks after the surgery, until your doctor says it is time to resume your usual activities, including exercise.
To treat a pituitary tumor with radiation, doctors may use a variety of techniques depending on the size and location of the tumor. Conventional radiation covers a wide area in and around the tumor and is usually given daily for several weeks. A number of more focused "radiosurgery" therapies are also available and may be appropriate for your case including proton beam. These methods begin with an MRI scan to image your brain. The scan locates the precise location and size of the tumor. After the MRI, you go into a special treatment room. Using the points mapped from the MRI, several narrow beams of high-dose radiation are delivered to the exact tumor location. These beams are so precise that they can avoid the normal tissue surrounding the tumor. All radiation therapy works slowly and it may take from six months to several years for your condition to improve. This is why radiation therapy is typically used together with other therapies. It is important to have an evaluation for radiation therapy at a center with expertise in treating pituitary tumors.
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