Pituitary adenomas

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Overview

Prolactinomas and nonfunctioning adenomas are the most common types of pituitary adenomas. Patients with pituitary adenomas may present initially with symptoms of endocrine dysfunction such as infertility, decreased libido, and galactorrhea, or with neurologic symptoms such as headache and visual changes. The diagnosis may also be made following imaging done for an unrelated issue in an asymptomatic patient; this is termed a pituitary incidentaloma. Oversecretion of hormones from a dysfunctional pituitary gland may result in classic clinical syndromes, the most common of which are hyperprolactinemia (from oversecretion of prolactin), acromegaly (from excess growth hormone), and Cushing disease (from overproduction of adrenocorticotropic hormone). In the diagnostic approach to a suspected pituitary adenoma, it is important to evaluate complete pituitary function, because hypopituitarism is common. Therapy for pituitary adenomas depends on the specific type of tumor, and should be managed with a team approach to include endocrinology and neurosurgery when indicated. Dopamine agonists are the primary treatment for prolactinomas. Small nonfunctioning adenomas and prolactinomas in asymptomatic patients do not require immediate intervention and can be observed.

Symptoms

Headaches.

Vision problems.

Weight gain.

Easy bleeding/bruising.

Change in bone structure, especially in the face and hands.

Menstrual irregularities.

Lactation.

Erectile dysfunction.

Causes

Pituitary microadenomas develop when DNA mutations cause cells in the pituitary gland grow and divide uncontrollably. Experts are not entirely sure what causes these genetic mutations to happen. A small percentage of pituitary tumors run in families, but most cases do not have any obvious hereditary factor.

Risk factors

Pituitary tumors have very few known risk factors, and these are related to genetics. There are no known environmental or lifestyle-related risk factors for pituitary tumors. Though science has suggested that people who are overweight or obese might be at increased risk.

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Complications

Pituitary tumors usually don't grow or spread extensively. However, they can affect your health, possibly causing:

Vision loss. A pituitary tumor can put pressure on the optic nerves.

Permanent hormone deficiency. The presence of a pituitary tumor or the removal of one may permanently alter your hormone supply, which may need to be replaced with hormone medications.

A rare but potentially serious complication of a pituitary tumor is pituitary apoplexy, when sudden bleeding into the tumor occurs. It feels like the most severe headache you've ever had. Pituitary apoplexy requires emergency treatment, usually with corticosteroids and possibly surgery.

Prevention

Unfortunately, there’s nothing you can do to prevent developing a pituitary adenoma. Most pituitary adenomas occur randomly, but they’re also associated with certain rare genetic conditions as noted above.

If you have a first-degree relative (sibling or parent) who has one of these conditions, you may want to get genetic testing to check to see if you have it as well. This may help screen for and catch a pituitary adenoma in its early phases. Your healthcare provider may recommend regular blood tests of your pituitary hormone levels to increase the odds of finding and treating a pituitary tumor before it creates problems.