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Pituitary Tumors
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Tumors that arise around the pituitary gland are most often benign and are usually treated with surgery as first line therapy. The up front surgical technique allows for biopsy for diagnosis and may relieve the pressure exerted on nearby structures by the tumor. More common tumors that arise within or around the pituitary gland include pituitary adenomas, meningiomas, and craniopharyngiomas. Meningiomas are described on another page of this web site. The pituitary gland is located at the bottom or base of the skull almost directly deep to the nose in the center of the head. Its function is to generate hormones that will, in turn, regulate a wide variety of bodily functions. These functions include thyroid gland regulation (metabolic rate), sex hormone production (libido and fertility), adrenal gland regulation (metabolism and stress response), breast development and lactation, growth regulation, the ability to concentrate urine, and others. The nerves that allow visual perception cross just in front of the pituitary gland, and the nerves that move the eyes and give sensation to the eyes and face are just lateral to the pituitary gland. As such, a tumor growing within or around the pituitary gland can interfere with any of the functions described in this paragraph. Pituitary adenomas arise within the pituitary gland itself from the cells that would otherwise produce regulatory hormones. Pituitary adenomas may be large (macroadenomas) or small (microadenomas) and may produce an oversupply of a particular hormone (e.g. growth hormone in acromegaly) or no hormone (null adenoma). Treatment options include surgical removal (e.g. transphenoidal resection), medical therapies (e.g. bromocriptine), conventional daily fractionated radiation therapy, and Gamma Knife radiosurgery. Gamma Knife radiosurgery has the advantage of ideal conformality of high radiation dose to include tumor while excluding surrounding normal tissue. In addition, there is some evidence that Gamma Knife radiosurgery may preserve residual pituitary gland function while effectively halting the growth of the tumor. It is, however, limited by issues of toxicity to tumors which do not directly touch the optic nerves. Nonetheless, Gamma Knife radiosurgery is an effective second line therapy or as primary therapy in those who cannot tolerated the rigors of surgical resection. Craniopharyngiomas are fairly rare tumors that arise about the pituitary gland from tissues involved in fetal development. These tumors are more common in young people. The tumor cells are known to secrete a oily fluid resulting in often multiple cysts throughout the solid component of the tumor. These cysts may grow to fairly large dimensions. Treatments for craniopharyngioma often involve combinations of surgery, conventional radiation therapy, Gamma Knife radiosurgery, cyst drainage procedures, and radioactive colloid cystic therapy. Gamma Knife radiosurgery is used with similar benefits and limitations as described above for pituitary adenomas. [Keywords: pituitary gland, pituitary adenomas, meningiomas, craniopharyngiomas, pituitary tumors] |
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