What're the treatments for pituitary tumors?
Treatment of pituitary tumors requires the coordinated care of a neurosurgeon and neuroendocrinologist. Early intervention provides the best chance for cure or control of the tumor and its systemic effects. The unique location of the pituitary gland in relation to the sinuses of the nasal cavity allows for removal of tumors arising in this area through a number of surgical approaches. The neurosurgeon may use a transphenoidal approach, capitalizing on the pituitary's location at the back of the
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nasal cavities. Approaching from either above the gum line or through the nose, the neurosurgeon employs the surgical microscope to remove the tumor through a small hole in the posterior wall of the sphenoid sinuses. This is the most common technique. In the case of large pituitary tumors which cannot be safely removed through the transphenoidal approach, a craniotomy made on the front or side of the skull allows direct access to the area of the pituitary from an intracranial approach utilizing slight elevation of the brain and then microsurgical resection.
Treatment is determined by the type of tumor and by whether it has invaded tissues adjacent to the pituitary gland. Hormone-secreting tumors can be successfully treated with surgery, radiation, bromocriptine (Parlodel), Sandostatin (Octreotide), or other somatostatin analogues (drugs similar to somatostatin). Surgery is usually used to remove all or part of a tumor within the gland or the area surrounding it, and may be combined with radiation therapy to treat tumors that extend beyond the pituitary gland. Removal of the pituitary gland requires life-long hormone replacement therapy. Radiation therapy should not be used routinely for pituitary tumors. Damage to the remaining pituitary occurs frequently and may also cause blindness due to injury of the optic nerves. Individuals who have had their tumors resected are followed with yearly MRI and recurrences are treated with reoperation. Radation is reserved for those unresectable tumors that continue to grow.
Some pituitary tumors stabilize without treatment, but a neurosurgeon will operate at once to remove the tumor (adenectomy) or pituitary gland (hypophysectomy) of a patient whose vision is deteriorating rapidly. Patients who have pituitary apoplexy may experience very severe headaches, have symptoms of stiff neck, and sensitivity to light. This condition is considered an emergency. Magnetic resonance imaging (MRI) is the best imaging technique for patients with these symptoms. If the tumor is small, surgery may be done through the nose. If the tumor is large, it may require opening the skull for tumor removal. Selected patients do well with proton beam radiosurgery (the use of high energy particles in the form of a high energy beam to destroy an overactive gland). |
