The pituitary is the “master gland” that protrudes from the bottom of the hypothalamus in the brain, just behind the eyes. It is a pea-sized gland that works hand-in-hand with hypothalamus to regulate the essential functions of the body.
The pituitary gland controls the other glands and maintains hormonal balance all over the body. This way, the pituitary gland is responsible for growth, development, and reproduction. It also controls the function of the vital organs, such as the kidneys, breasts, and uterus in women.
Without pituitary gland, the water balance, blood pressure, energy balance, temperature regulation, reproductive functions, and metabolism can go haywire. Thus, pituitary gland plays a significant role in helping us lead a healthy life.
Pituitary gland tumors are one among the common brain tumors reported in India. Nearly all pituitary adenomas are non-cancerous, abnormal growth in the pituitary gland. They are usually slow-growing and benign, which means they remain localized and do not spread to other parts of the body (benign). On the other hand, pituitary carcinomas (neuroendocrine tumors) are rare, aggressive, cancerous and spread to other parts of the body (malignant).
As the pituitary adenomas grow in size, they may compress nearby structures, such as the nerves connecting eyes to the brain. This “mass effect” can result in symptoms related to the organs affected, vision changes as in this case. Large pituitary adenomas (pituitary macroadenomas) can also crush the normal pituitary cells and alter their regulatory activities.
Based on their influence on hormonal secretions, pituitary adenomas are either functional or nonfunctional:
Functional pituitary adenomas: Pituitary adenomas that release hormones (usually in excess) are called as functional pituitary adenomas. Based on the hormones they secrete and the resulting symptoms, they are further classified as –
Non-functional pituitary adenomas do not secrete active hormones. About one-third of the pituitary adenomas are non-functional. They usually grow in size and produce symptoms due to mass effect, leading to a condition called hypopituitarism (diminished hormone secretion by the pituitary gland, causing dwarfism in children and premature aging in adults).
Based on the size of the tumor, pituitary adenomas are called as microadenomas or macroadenomas:
Pituitary microadenomas, tumors smaller than one cm.
Pituitary macroadenomas, tumors larger than one cm.
Pituitary adenomas show symptoms related to changes in hormone release and mass effect of large tumors on the nearby structures.
Symptoms related to excess hormones:
Symptoms related to mass effect from pituitary macroadenomas or pituitary carcinomas:
General symptoms of pituitary adenomas include:
Pituitary gland tumors are usually spontaneous and not inherited. The exact reason for the tumorous growth is unknown. According to American Cancer Society, there are no causative lifestyle-related or environmental factors for pituitary adenomas.
Pituitary adenomas may occur as a result of genetic mutations caused by exposure to harmful radiations and cancer-causing chemicals.
There are very few risk factors associated with pituitary gland tumors. Some cases are related to inherited syndromes; however, not everyone having them will have pituitary adenomas.
Family history: Pituitary tumors do not run in families. When found they are also related to other tumors as a part of inherited genetic syndromes.
People with certain inherited syndromes: Genetic mutations and their associated family cancer syndromes include multiple endocrine neoplasias, McCune-Albright syndrome, and Carney complex.
Pituitary adenomas rarely progress to pituitary carcinoma, so there is no staging developed for it. The significant features of pituitary adenomas which help in monitoring the progress of the tumor include:
Based on the above factors, untreated pituitary adenomas may lead to serious symptoms, complications and comorbidities.
There are no recommended screening tests to detect pituitary adenomas for people without symptoms or risk factors. Therefore, early detection of pituitary adenomas are rare, and a result of brain scans done for unrelated problems.
Small-sized functional adenomas are easier to detect than the non-functional ones. This is because non-functional adenomas do not cause any symptoms until they grow large enough to press on the nearby tissues.
Neurologists perform following checks to diagnose pituitary adenomas:
For functional pituitary adenomas:
Medicines are often the only treatment needed.
For non-functional pituitary adenomas:
Follow-up care: Once the treatment procedures are complete, doctors want to monitor the recovery for months and years ahead. After surgery, the patient is followed-up by an endocrinologist and a neurosurgeon on a regular basis. It is important to discuss symptoms such as fatigue, gastrointestinal upset, gallstones, and vision problems.
More than 1 million cases of pituitary adenomas are reported in India every year. Although early diagnosis is difficult in many cases, unlike before, pituitary gland tumors are now treatable with medicines and advanced technologies such as stereotactic radiosurgery and endoscopic surgeries. Pituitary adenomas are commonly associated with vision changes and headache. Do not ignore the symptoms, consult a neurologist or neurosurgeon for medical advice.
About Author –
Dr. Ravi Suman Reddy, Senior Neuro & Spine surgeon, Yashoda Hospitals – Somajiguda
MCH (NIMHANS), Advanced training in Stereotactic Radiosurgery (Brain Lab Academy – Germany). His expertise includes frameless stereotactic neurosurgery, minimal invasive spine surgery, spine stabilization, cranial micro neurosurgery, cranio-spinal trauma, and endoscopic surgery.
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My father lost his total vision on Feb 2017 due to pituitary macrodenoma is there any chance to get vision back sir please respond
There are very limited chances of regaining vision lost due to a pituitary tumor. However, the condition may be evaluated by a neurologist for a final answer. Please share your contact details here or at info@yashodamail.com so we can be of further help.