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Treatments and drugs
By Mayo Clinic staffTreatment for a pituitary tumor depends on the type of tumor, its size and how far it has grown into your brain. Your age and overall health also are factors. Because pituitary tumors can cause serious problems by putting pressure on your brain, treatment often is necessary. Early detection of pituitary tumors is key to successful treatment.
Treatment often involves a team of medical experts, including:
- A brain surgeon (neurosurgeon)
- An ear, nose and throat surgeon (otorhinolaryngologist)
- A doctor who specializes in disorders of the endocrine glands (endocrinologist)
- A doctor who specializes in interpreting medical images (radiologist)
- A doctor who specializes in radiation therapy (radiation oncologist)
- A doctor who specializes in the nervous system (neurologist)
Doctors generally use surgery, radiation therapy and medications, either alone or in combination, to treat a pituitary tumor and return hormone production to normal levels.
Surgery
The most common treatment for pituitary tumors is surgery. Surgical removal of a pituitary tumor usually is necessary if the tumor is pressing on the optic nerves, which can cause loss of vision. The success of surgery depends on the tumor type, its location, its size, and whether the tumor has invaded surrounding tissues. The two main surgical techniques for treating pituitary tumors are:
- Endoscopic transnasal transsphenoidal hypophysectomy. With this approach, a doctor usually can reach and remove the tumor through your nose and sinuses without an external incision. No other part of your brain is affected, and there's no visible scar. However, very large tumors may be difficult to remove with this procedure, especially if a tumor has invaded nearby nerves or brain tissue.
- Transcranial hypophysectomy. During this procedure, the tumor is removed through the upper part of your skull by way of an incision in your scalp. It's easier to reach large or more complicated tumors using this procedure.
Radiation therapy
Radiation therapy uses high-energy X-rays to destroy tumors. It can be used after surgery or alone as primary treatment if surgery isn't an option. Radiation therapy can be beneficial if a tumor persists or returns after surgery and causes signs and symptoms that medications don't relieve. Methods of radiation therapy include:
- External beam radiation. This form of radiation therapy delivers radiation in small increments over a period of time. A series of treatments, usually five times a week over a four- to six-week period, is performed on an outpatient basis. While this therapy is often effective, it may take years to fully control the tumor growth and hormone production. Radiation therapy may also damage remaining normal pituitary cells and normal brain tissue, particularly near the pituitary gland.
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Gamma-knife radiosurgery. This type of radiation therapy focuses radiation beams precisely on the tumor without an incision. Radiation beams that are the exact size and shape of the tumor are delivered into the tumor with the aid of special brain-imaging techniques. With gamma-knife radiosurgery, a minimal amount of radiation comes in contact with healthy tissue surrounding the tumor, decreasing the risk of damage to normal tissue.
The benefits of gamma-knife radiosurgery, like those of external beam radiation, often aren't immediate and may take months or years to be fully effective. However, doctors can't use this therapy if the tumor is very close to the optic nerves or other sensitive structures.
Medications
Treatment with medications (drug therapy) may help to block excess hormone secretion and sometimes shrink certain types of pituitary tumors:
- Prolactin-producing tumors (prolactinomas). The drugs bromocriptine (Parlodel) and cabergoline (Dostinex) can treat these types of tumors by decreasing prolactin secretion and often reducing the size of the tumor. These drugs are often so effective in treating these types of tumors that surgery isn't necessary.
- Growth hormone-producing tumors. Two classes of drugs are available for these types of pituitary tumors. Drugs known as somatostatin analogs (Sandostatin, others) cause a decrease in growth hormone production and may decrease the size of the tumor. Pegvisomant (Somavert) blocks the effect of excess growth hormone on the body. These medications are especially useful if surgery has been unsuccessful in normalizing growth hormone production.
If a pituitary tumor has resulted in decreased hormone production, or if removal of a pituitary tumor has lowered hormone production, you may need to take replacement hormones to maintain normal hormone levels.
Watchful waiting
In watchful waiting — also known as observation, expectant therapy or deferred therapy — you may need regular follow-up tests to monitor for evidence of progression of your pituitary tumor. Watchful waiting involves no active medical treatment. Medications, radiation therapy and surgery aren't used. Watchful waiting may be an option if your tumor isn't causing any signs or symptoms.
Watchful waiting may be particularly appropriate if you're older, in poor health or both. Many people with pituitary tumors function normally without treatment and without the tumor causing other problems. If you're younger, watchful waiting can also be an option as long as you know the facts and accept the possibility of your tumor changing or growing during the observation period, possibly requiring medical treatment. You and your doctor can weigh the risk of symptoms developing versus treatment intervention.
