The specialists at the Peak Brain & Pituitary Tumor Center have access to advanced technology to detect, diagnose and treat pituitary adenomas (non-cancerous), pituitary carcinomas (cancerous), and other types of tumors that grow in and around the pituitary gland. Peak Center physicians work collaboratively and seamlessly with specialists from other areas of medicine so patients benefit from the full breadth of Houston Methodist Hospital excellence.
Most pituitary tumors can be treated. Virtually all tumors can be removed surgically or reduced in size with other means, and prognosis for patients is excellent.
Doctors must first determine the size of the pituitary tumor. To do that, they will order CT and/or MRI scans. An ophthalmologist may also be consulted to do visual acuity and field tests to determine whether the tumor is pressing on one or both optic nerves or other parts of the visual system. An endocrinologist will measure hormone levels in the blood and urine to see whether pituitary-related hormone levels are abnormal.
There are four different types of treatment approaches:
Sometimes, the safest course of treatment for patients is simply to observe and monitor the growth of a tumor. Many tumors are small and are not growing or are growing very slowly, and may have few adverse impacts on a patient's health. For older patients (age 70 and above), observation with regular visits to the Peak Center may be recommended.
One type of pituitary tumor, called a prolactinoma because it causes an increase in the production of the hormone prolactin, can be effectively treated in many cases with the drugs bromocriptine or cabergoline. These drugs stop tumor growth, often cause a reduction in the size of the tumor, and usually decrease excess prolactin. Drug treatment does not usually eliminate the tumor, however, and treatment must be continued over a period of many years. Side effects from the drugs include nausea, headaches, dizziness, and weakness, but may be managed by slowly ramping up the amount of drug being used. Drug treatment may be selected as the only treatment needed, or may be used in combination with other treatments.
Tumors that make growth hormones can also be treated with medication. Usually medication is used to control residual tumors that cannot be safely removed surgically, and often can help avoid the use of radiation treatments.
Highly focused radiation therapy called stereotactic radiosurgery is sometimes used after surgery, in the minority of cases in which all of the tumor cannot be removed. Many people think radiotherapy is only used in cases of cancer, but it can be even more effective in treating pituitary adenomas and other benign tumors.
A specialized form of radiotherapy called stereotactic radiosurgery is a technique that focuses two or more lower-intensity radiation beams at the tumor with minimal effect on surrounding tissue. Radiation therapy is painless. Treatment can often be performed in one to five sessions on an outpatient basis. Newer techniques have much less effects on the surrounding pituitary gland, and in most cases can spare pituitary function.
Depending on the nature of the pituitary adenoma or carcinoma and the patient's outlook, Peak Center surgeons may recommend surgical removal. Surgery can almost always be performed in a minimally invasive way, endoscopically, through the nose (transsphenoidal surgery). Alternately standard surgical removal may be recommended through craniotomy (or transcranial) surgery, in which a small portion of the skull is removed so surgeons can access the tumor. Advances in surgical technology make even the transcranial procedure minimally invasive.
The transsphenoidal (minimally invasive) operation is the most common for a pituitary tumor. The approach for this operation is through the nose, so there is no incision. The procedure is done with an endoscope, which is a slender rod (2.8 mm in diameter) with a camera on the end of it. This surgical approach provides the best exposure of the tumor with the lowest risk. The technology is so advanced that the picture provided to the surgeon has the resolution of a blue ray DVD player. The operation normally takes two or three hours. Following the operation, most patients spend one day in the intensive care unit, then typically just one day in their hospital rooms. In many cases, patients are sent home the day after surgery.
The craniotomy operation involves making an incision on the scalp. A small piece of bone is lifted out and the coverings over the brain are opened. Advances in surgical technique at the Peak Center enable tumor removal to be performed using virtual reality navigation and no longer requires lifting or moving brain structures. Rather, surgery is performed through natural crevices in the brain, without entering into the brain at all or manipulating it as has been necessary in the past. The small piece of bone is then replaced and the scalp is closed with stitches or staples. In all cases, the incision on the head can be placed so that the hair hides the scar. This type of operation is sometimes necessary if the tumor is very large and/or it cannot be reached through the nose.
For more information about surgical options and risks, click here.
Houston Methodist Hospital and its peer institutions throughout the United States are engaged in many clinical trials of drugs and other treatment options that are still in development. To find out more about active clinical trials related to pituitary tumors, please visit:
To schedule a consultation with a Peak Center pituitary tumor expert, please call 713.441.8500