Pituitary Adenoma Surgery and Treatment in New Jersey

Pituitary adenomas are a type of benign brain tumor that affects patients in many ways. The most efficient treatment for this condition is surgery, which removes tumors and relieves patients of their symptoms. Patients across northern New Jersey can find comprehensive treatments for pituitary adenomas at Centers for Neurosurgery, Spine & Orthopedics (CNSO). The medical team takes a conservative approach to pain management and treatment, assisting patients throughout their care journey. Learn more about pituitary adenoma surgery at CNSO.

What Is a Pituitary Adenoma?

A pituitary adenoma is a benign tumor that grows in a patient’s pituitary gland. When a tumor is benign, the condition is noncancerous and does not spread to other areas of the brain or body.

The pituitary gland is a small, pea-sized structure in the base of the brain that is connected to the hypothalamus. The pituitary gland is composed of two separate lobes, each responsible for producing and releasing different hormones. These lobes are designated as either the anterior lobe or the posterior lobe.

The hormones the pituitary gland produces are essential for initiating or stopping specific bodily functions. These hormones carry messages via the blood to the muscles, tissues, and organs. The pituitary gland releases many different types of hormones, including:

• Thyroid-stimulating hormone (TSH)
• Adrenocorticotropic hormone (ACTH or corticotrophin)
• Prolactin
• Antidiuretic hormone (ADH)
• Oxytocin
• Follicle-stimulating hormone (FSH)
• Luteinizing hormone (LH)
• Growth hormone (GH)

Through the release of hormones, the pituitary gland regulates how the rest of the body releases hormones. It emits messages to other glands in the endocrine system, instructing when to secrete other hormones. When a tumor grows within the pituitary gland, it can impact how the pituitary gland releases one or more hormones. As a result, the excessive release of pituitary hormones causes an excessive release of other hormones that cause a resultant disturbance in bodily functions. Neurosurgeons and endocrine specialists classify pituitary adenomas as brain tumors, because the affected pituitary gland is in the brain, even though the tumor hormone production affects the endocrine system.

Although noncancerous, pituitary adenomas can still impact how the brain and body functions. Pituitary adenomas can grow to a size that puts pressure on nearby brain structures, including the optic chiasm. This pressure can cause unusual symptoms to arise, depending on the areas of the brain the pituitary tumor compresses. Patients with a pituitary tumor may have their vision impacted and lose their peripheral vision, have elevated blood pressure, or secrete milk from their breasts. Other symptoms may be also experienced.

What Are the Signs and Symptoms of Pituitary Adenoma?

Individuals with smaller pituitary tumors (microadenoma) may never be diagnosed with the condition. This is because the tumors may not alter hormone production or compress nearby brain structures. Consequently, no symptoms will be evident. However, if the pituitary adenoma produces excessive hormones, patients will experience resulting symptoms. If a patient develops a large enough pituitary tumor (macroadenoma), the growth will push on the surrounding brain structures and cause a variety of symptoms, including:

Growth Hormone (GH) Deficiency or Excess

When a hormone is excessive or deficient can impact a patient’s symptoms. Hormone deficiencies occur when tumors grow too large and damage pituitary gland tissues. For example, those with low growth hormones may notice a decrease in muscle mass, as well as increased fatigue. Patients with an excess of growth hormone may experience opposing symptoms, like high growth muscle density and mass, enlarged heart, enlarged jawline, and frontal bossing.

Headaches

Growing pituitary adenomas can push on other brain structures and cause feelings of pressure within the head. High blood pressure caused by high ACTH can also lead to headaches. Patients may complain of frequent and global headaches if they have pituitary tumors.

Vision Problems

Growing pituitary tumors can become so large that they can push onto the optic chiasm, which impacts a patient’s peripheral vision. Patients may also notice symptoms like double or blurry vision.

Elevated Blood Pressure

Those with low ACTH production have a resultant low cortisol level that can lead to low blood pressure, pain in the abdomen, nausea, and vomiting. Yet those with high ACTH have high blood pressure and could experience the resultant complications of high blood pressure. For example, some pituitary adenomas can release excess adrenocorticotropic hormone (ACTH), which causes the body to produce steroid hormones like cortisol. This can lead to the development of Cushing’s syndrome, which can cause the following symptoms:

• Compression fractures
• High blood pressure
• Osteoporosis
• Weakness in muscle
• Easy bruising

Secretion of Breast Milk

Some pituitary adenomas, called prolactinomas, secrete prolactin. These tumors cause hyperprolactinemia, which leads to breast milk secretion and infertility. Both can be reversed with proper medication and/or surgery.

Risk Factors and Causes for Pituitary Adenomas

Pituitary adenomas can affect anyone of any age. However, most tumors grow in patients around 30 to 40 years old. Pituitary adenomas are more commonly found in women than in men. While the cause of pituitary adenomas is unclear, some believe they can stem from DNA changes and mutations. These DNA changes can cause an overgrowth of cells, forming a mass (or tumor). Parents can pass these genetic changes down to children.

Those with the following conditions are more susceptible to developing a pituitary adenoma:

• Von Hippel-Lindau syndrome
• Multiple endocrine neoplasia type 1
• Multiple endocrine neoplasia type 4
• Neurofibromatosis type 1
• Carney complex
• Succinate dehydrogenase-related familial pituitary adenoma
• X-LAG syndrome, a condition that causes abnormally rapid growth in children

Patients can complete genetic tests to determine if they have these conditions or genetic changes.

Types of Pituitary Adenoma Tumors

Patients can be diagnosed with one of many types of pituitary tumors. During diagnosis, specialists will determine the patient’s type of pituitary tumor depending on many factors. For example, they may categorize it as functioning or nonfunctioning if the growth produces extra hormones.

A functioning adenoma means the tumor releases additional pituitary hormones. A nonfunctioning adenoma is a growth that does not release added hormones but still impacts surrounding brain parts. Nonfunctioning pituitary adenomas are more common than functioning adenomas.

The tumor’s size also can impact how brain care specialists diagnose it. If a patient’s growth is larger than 10 millimeters, the patient has a macroadenoma. Macroadenomas can cause a condition called hypopituitarism, where the body lacks the normal levels of one or more hormones. If a patient has a growth smaller than 10 millimeters or one centimeter, they have a microadenoma.

Diagnosing a Pituitary Adenoma

Diagnosis for a pituitary adenoma can happen in many ways. For patients without symptoms, diagnosis may not occur until a patient is diagnosed with an unrelated condition. This is because some pituitary adenomas cause no symptoms, meaning some patients do not realize they have one until undergoing imaging exams for other conditions.

If a patient does have symptoms, they most likely will be diagnosed with the condition that the pituitary adenoma causes. For example, if a patient has a tumor that releases excess ACTH hormone, they may be diagnosed with Cushing’s syndrome. Treatments will focus on resolving symptoms of the patient’s condition.

Alongside imaging exams like computed tomography (CT) or magnetic resonance imaging (MRI), brain care specialists can diagnose pituitary adenomas using other techniques, such as:

• Eye exam: Brain care specialists test vision to see if the tumor impacts the patient’s eye function.
• Blood test: This can help detect specific hormone levels in patients, making it easy to identify if there is an abundance or loss of hormones.

Surgical Approaches to Pituitary Adenoma Treatment

Brain surgery is the most common approach to pituitary adenoma treatment. However, neurosurgeons may use different surgical techniques depending on the size and location of the tumor. Brain surgeons also account for whether the growth has spread into surrounding brain areas. The goal of brain tumor surgery is to remove as much of the tumor as safely possible, without damaging blood vessels and nerves.

If a tumor is small, neurosurgeons are more likely to be able to remove it in its entirety, effectively treating the patient of their condition. Brain surgeons work alongside ear, nose, and throat (ENT) surgeons to complete the surgery. Surgical options for a pituitary adenoma include:

Transsphenoidal Surgery

Transsphenoidal surgery is a minimally invasive brain surgery that involves using specialized tools, like an operating microscope, through the nostril. Brain surgeons make a small incision inside the nose and use microscopic tools to open sphenoid sinus walls. This allows neurosurgeons to access the tumor without creating a visible scar. It also allows for a quicker recovery.

Endoscopic Pituitary Surgery

Endoscopic brain surgery is a modern, advanced type of minimally invasive brain surgery that uses an endoscope. It works similarly to transsphenoidal surgery, but instead of an operating microscope, neurosurgeons use an endoscope with a small video camera at the end. This provides enhanced visibility while operating.

Transcranial Surgery

Brain surgeons perform transcranial surgery (also called craniotomy) when minimally invasive techniques will not work to remove a tumor. Some patients may have a pituitary adenoma that sits in a difficult-to-reach area or near essential brain structures. This makes it challenging for neurosurgeons to operate using minimally invasive techniques. In this case, they use transcranial surgical methods, which involve opening the skull to allow complete access. Brain surgeons go in between the brain folds to reach the tumor.

With recent developments in healthcare, minimally invasive surgical approaches have become more common than more major techniques. These techniques allow neurosurgeons to operate on the brain effectively without touching essential brain areas. This means patients experience fewer post-operative complications and no visible scarring. The brain surgeons at CNSO utilize minimally invasive techniques whenever possible.

Medical Treatments for Pituitary Adenoma

Depending on the size, type, and location of the tumor, neurosurgeons or endocrinologists may determine that the use of oral medications to shrink the tumor size is all that is necessary. Treatments patients can receive for their pituitary adenoma include:

Medication Therapy

Medication therapy can work for patients with prolactinomas, a type of hormone-secreting pituitary tumor. Patients take medications to restore normal prolactin levels and decrease the size of their pituitary tumors. Depending on the type of medication therapy a patient receives, they may require one or multiple sessions. If the growth does not change after medication therapy, brain surgeons then consider surgery.

Radiation Therapy

Radiation therapy uses high-energy beams called photons to treat specific brain areas. The beams work to shrink and kill off tumor cells. Patients receive multiple sessions of radiation therapy over a few days or weeks.

Proton Beam Therapy

Proton beam therapy is a different type of radiation therapy that uses protons to deliver energy and shrink tumors. This treatment allows brain care specialists to give high doses of radiation to specific brain areas, meaning nearby brain structures remain unharmed. The higher radiation doses allow for faster, more efficient pituitary adenoma treatment.

Stereotactic Radiosurgery

Stereotactic radiosurgery (gamma knife surgery, CyberKnife, or Lineic Accelerator) uses traditional high-energy beam radiation and combines it with 3D imaging. The 3D imaging allows brain care specialists to deliver precise doses of radiation to the affected area. Brain surgeons can complete stereotactic radiosurgery in one session. This is not a traditional type of surgery in which patients receive an incision. Patients may have an easier recovery than traditional surgical methods.

Hormone Replacement Therapy

Some patients may require hormone replacement therapy after the surgical removal of their tumor, because the remaining pituitary gland may not produce adequate amounts of the hormones. To return the body to a normal state, these patients require hormone replacement therapy. Hormone replacement therapy comes in the form of a pill that patients take to promote the production of any of the deficient hormones. Most of the time, if any replacement is required it is only one or two of the following hormones:

• Adrenal hormones
• Estrogen
• Growth hormone
• Progesterone
• Testosterone
• Thyroid hormone

Recovering From Pituitary Adenoma Surgery

Recovery from the surgical removal of a pituitary adenoma is a different process for each patient. Those undergoing minimally invasive surgery can experience easier and faster recovery than the few who require a craniotomy. Patients receiving minimally invasive surgery must remember that the surgery is still major, and they must adhere to specific post-operative care protocols.

While extremely rare, patients may experience complications immediately following surgery, like allergic reactions to anesthesia, bleeding, or infections. More commonly, a patient will report sinus headaches and congestion for one or two weeks after surgery. For patients undergoing minimally invasive brain surgery, recovery can take a few weeks. Patients having a craniotomy can expect to heal over a couple of months.

Seek Treatment for Pituitary Adenomas at CNSO

The comprehensive team at CNSO is expert at all stages of pituitary adenoma treatment, from diagnosis to medical management to surgery. Patients across northern New Jersey, including Passaic, Essex, Morris, and Hudson counties, can access an award-winning, compassionate team of neurosurgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists at CNSO’s convenient locations.

Patients can feel comfortable with their medical care as the team uses the latest, most advanced technologies. To learn more about pituitary adenoma surgery, contact CNSO today.