Treatments and drugsBy Mayo Clinic staff
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|Endoscopic transnasal transsphenoidal surgery|
Treatment 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 involves a team of medical experts, possibly including a brain surgeon (neurosurgeon), endocrine system specialist (endocrinologist) and a nervous system specialist (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.
Surgical removal of a pituitary tumor usually is necessary if the tumor is pressing on the optic nerves, which can cause loss of vision, or if the tumor is overproducing certain hormones. 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 approach. 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 approach (craniotomy). 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 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.
- Gamma Knife stereotactic 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 stereotactic 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 this type of surgery, 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.
Treatment with medications may help to block excess hormone secretion and sometimes shrink certain types of pituitary tumors:
- Prolactin-secreting tumors (prolactinomas). The drugs bromocriptine (Parlodel, Cycloset) and cabergoline 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. Possible side effects of these drugs include drowsiness, dizziness, nausea, vomiting, diarrhea or constipation, confusion, and depression. Some people may also develop compulsive behaviors, such as gambling, while taking these medications.
- Growth hormone-secreting tumors. Two types of drugs are available for these types of pituitary tumors and are especially useful if surgery has been unsuccessful in normalizing growth hormone production. Drugs known as somatostatin analogs (Sandostatin, Somatuline Depot, others) cause a decrease in growth hormone production and may decrease the size of the tumor. These drugs can have minor side effects, such as nausea, vomiting, diarrhea, stomach pain, dizziness, headache and pain at the site of injection, though many of these side effects improve or even go away with time. They can also cause gallstones and may worsen diabetes if you already have it. Pegvisomant (Somavert) blocks the effect of excess growth hormone on the body. This drug has few side effects, except it may cause liver damage in some people.
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.
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, which involves no active medical treatment, may be an option if your tumor isn't causing any signs or symptoms.
Watchful waiting may be particularly appropriate if you're older or in poor health. Many people with pituitary tumors function normally without treatment if the tumor isn't causing other problems. If you're younger, watchful waiting also can be an option as long as you accept the possibility of your tumor changing or growing during the observation period, possibly requiring treatment. You and your doctor can weigh the risk of symptoms developing versus treatment.
- Pituitary tumors information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/pituitary_tumors/pituitary_tumors.htm. Accessed Aug. 6, 2012.
- Pituitary tumors. American Cancer Society. http://www.cancer.org/Cancer/PituitaryTumors/DetailedGuide/index. Accessed Aug. 6, 2012.
- Pituitary tumors treatment — Health professional version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/pituitary/HealthProfessional. Accessed Aug. 6, 2012.
- Ferri FF. Ferri's Clinical Advisor 2013: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-08373-7..00002-9&isbn=978-0-323-08373-7&about=true&uniqId=343863096-23. Accessed Aug. 6, 2012.
- Pituitary tumors treatment — Patient version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/pituitary/Patient. Accessed Aug. 6, 2012.
- Erickson DX (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 21, 2012.
- Parlodel (prescribing information). East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2012. http://www.pharma.us.novartis.com/product/pi/pdf/parlodel.pdf. Accessed Nov. 13, 2012.
- Cycloset (prescribing information). San Diego, Calif.: VeroScience, LLC; 2010. http://www.veroscience.com/CyclosetFDAapprovedPackageInsert.htm. Accessed Nov. 13, 2012.
- Cabergoline (prescribing information). Sellersville, Pa.: Teva Pharmaceuticals; 2012. http://www.tevagenerics.com/default.aspx?pageid=3364&sortby=ProductName&ProductName=Cabergoline+Tablets&BrandName=Dostinex%C2%AE+Tablets. Accessed Nov. 13, 2012.
- Martinkova J, et al. Impulse control disorders associated with dopaminergic medication in patients with pituitary adenomas. Clinical Neuropharmacology. 2011;34:179.