The Pituitary Center

The pituitary gland sits behind the nose at the base of the brain. It is thought of as the command center for the body’s endocrine or hormone system. It stimulates the thyroid gland to produce thyroid hormone, the adrenal glands to produce cortisol (or “stress hormone”), and the gonads to produce sex hormones. These hormones all help the body grow during childhood and keep it running smoothly in adulthood.

When tumors develop in the pituitary gland, patients may experience problems, including changes in their peripheral vision and hormonal problems.

The Pituitary Center at the Washington University School of Medicine and Barnes Jewish-Hospital, part of the Benign Brain Tumor Program at Siteman Cancer Center, provides exceptional care for patients with pituitary tumors. Founded in 2010, it is the first multidisciplinary center in the region dedicated to diagnosing and treating this condition. Our team offers surgical and non-surgical solutions, using advanced technologies that make it easier to remove tumors while sparing healthy tissues.

Pituitary tumors are almost always benign, which means that they aren’t considered a form of cancer. Most patients with pituitary tumors can hope to make a full recovery.

Multidisciplinary team

Patients who come to the Pituitary Center will be seen by Washington University Physicians who specialize in the treatment of pituitary disease and related conditions. They will identify your tumor correctly and develop a personalized treatment plan for you.

The Pituitary Center is directed by Albert H. Kim, MD, PhD and Julie Silverstein, MD. Our specialists include neurosurgeons, otolaryngologists, ENT surgeons, endocrinologists, radiation oncologists, and ophthalmologists.

Precision technologies

At Siteman Cancer Center, patients with pituitary tumors requiring surgery and/or radiation are treated using advanced, precise tools that allow for safer and more effective tumor removal, including:

  • Intraoperative MRI: An intraoperative MRI is an MRI scan conducted during a surgical procedure. This helps surgeons remove tumors more completely. Siteman was the first facility in the St. Louis region to have an intraoperative MRI, and Washington University neurosurgeons have the most extensive experience in the nation with using this technology.
  • Gamma Knife: Gamma Knife stereotactic radiosurgery is a form of radiation therapy that can replace surgery in certain cases. Often completed in a single session, the Gamma Knife procedure eliminates tumors by inducing ongoing cell death.
  • Proton beam radiation therapy: During proton beam therapy, a tumor is hit with a single stream of protons. Unlike other forms of radiation therapy, the proton beam can be adjusted to stop at a specific depth, which reduces damage to tissues surrounding the tumor. Siteman was the first institution in the region to offer proton beam technology.

What are the different types of pituitary tumor?

Pituitary adenomas

Most patients with a pituitary tumor have a pituitary adenoma, which is a very common brain tumor and is estimated to affect 1 in 6 people. “Adenoma” is another term for a benign tumor that occurs on a gland. Pituitary adenomas are further classified as either “functioning” or “non-functioning.”

  • Functioning pituitary adenomas release hormones, such as prolactin, ACTH (adrenocorticotropic hormone), growth hormone, or TSH (thyroid-stimulating hormone). This can lead to a number of conditions, depending on the particular hormones involved. Tumors that secrete an excess of growth hormone, for instance, cause patients to develop acromegaly. Tumors that release ACTH and cause the adrenal glands to produce too much cortisol lead to Cushing’s disease. Prolactinomas, or tumors that secrete prolactin, are the most common type of functioning adenoma. Tumors that produce TSH are rare but are a cause of hyperthyroidism or overactive thyroid.
  • Non-functioning pituitary adenomas do not produce hormones, but can cause symptoms related to the mass of the tumor.

Other types of pituitary tumors

  • Craniopharyngioma: These rare, benign tumors that occur near the pituitary gland or its stalk. They can occur in children and adults.
  • Rathke’s cleft cyst: A Rathke’s cleft cyst occurs between the anterior and posterior segments of the pituitary gland. It develops when these two segments do not close properly during fetal development. Rathke’s cleft cysts are benign and occur less frequently than pituitary adenomas. They can cause issues if they grow and push into nearby structures.
  • Pituitary cancer: In very rare cases, pituitary tumors can become malignant and metastasize to other parts of the body. If you are diagnosed with pituitary cancer, the multidisciplinary team will also include Washington University oncologists at Siteman Cancer Center to provide specialized care.

What are the symptoms of pituitary tumors?

Pituitary tumors can cause a variety of symptoms, and many patients are aware that something is wrong. The symptoms are produced by the mass of the tumor pushing against the normal parts of the pituitary gland and other nearby brain structures, and by the excess hormones the tumor secretes.

Symptoms caused by the tumor itself include:

  • Headaches
  • Loss of peripheral vision or loss of vision in one or both eyes
  • Double vision
  • Nausea/vomiting
  • Pain or numbness in the face

Patients experiencing an excessive amount of growth hormone, or acromegaly, may observe:

  • Gradual growth of the hands, feet, skull, and facial bones
  • Pain in the joints
  • Sweating
  • Heart problems, including high blood pressure
  • New or worsening issues with vision
  • Sleep apnea
  • Diabetes

Patients with Cushing’s disease, or abnormal levels of cortisol, often experience:

  • Weight gain, especially in the face and abdomen
  • Facial swelling
  • High blood pressure
  • Diabetes
  • Changes in the menstrual cycle
  • Low testosterone
  • Depression or other emotional changes
  • Muscle weakness and easy bruising
  • Osteoporosis

Patients with a prolactinoma, or prolactin-secreting tumor, may experience:

  • Nipple discharge
  • Breast tissue growth, if male
  • Low testosterone
  • Sexual dysfunction
  • Irregular periods
  • Infertility

If the tumor prevents the pituitary from producing enough hormones, patients may develop:

  • Symptoms of hypothyroidism, such as fatigue, weight gain, irregular periods
  • Symptoms of adrenal insufficiency, such as decreased appetite, weight loss, nausea and vomiting
  • Symptoms related to low sex hormones, such as low sex drive, erectile dysfunction and infertility in men and irregular or lack of periods, and infertility in women

In some cases, patients may not experience any symptoms at all and only learn that they have a pituitary tumor after undergoing imaging for a different reason.

Risk factors for pituitary tumors

There is no specific profile for a pituitary tumor patient. They can occur in people of all ages, although they are more common in younger patients.

Treatment for pituitary tumors

Even though pituitary tumors are benign, they can still require complex treatment plans. Many patients, especially those experiencing symptoms, will need to have their tumors removed through surgery. Some patients may also require high-dose radiation therapy. In addition, if the tumor is producing hormones or causing low hormone levels, the patient will need additional care to manage any conditions caused by the hormonal imbalance.

Tumors that secrete prolactin (or prolactinomas) are treated differently than other forms of pituitary tumors. Instead of removing them surgically, physicians often try to manage them with medications first.

If your tumor is not causing any symptoms, your care team may recommend “active surveillance” instead of active treatment. Active surveillance involves regular follow-up visits and scans to monitor the tumor and to make sure it isn’t growing.

Surgery for pituitary tumors

If the pituitary tumor is causing symptoms and is not a prolactinoma, it will first be treated with surgery.  Because the pituitary gland is located behind the nose, many tumors can be removed through the nasal passages. This is called a “transsphenoidal procedure,” or “endoscopic endonasal surgery.”

During the operation, your Washington University surgeons may use MRI scans to visualize their progress and ensure that they have removed as much of the tumor as possible.

The recovery time for a transsphenoidal procedure is usually fairly short. Patients remain in the hospital for one to three days before going home.

Several complications can be associated with pituitary tumor removal, but all of them can be treated. Hyponatremia, or low levels of blood sodium, occurs in up to 30% of patients who undergo surgery. To prevent hyponatremia, your care team will monitor your fluid intake after the operation. You will also be monitored for the development of diabetes insipidus which causes increased urination and thirst and occurs if there has been disruption of ADH (antidiuretic hormone) production from the pituitary gland.

After you are discharged, your pituitary care team will follow up with you to make sure that you are recovering well.

Radiation therapy for pituitary tumors

In some cases, patients are given radiation therapy to shrink or eliminate pituitary tumors. Your care team may recommend radiation therapy if the entire tumor could not be removed surgically, or if you have other health conditions that might complicate surgery or recovery.

At Siteman Cancer Center, pituitary tumor patients may be treated with sophisticated tools that deliver high doses of radiation directly to the tumor, minimizing the impact to the brain and spinal region.

Learn more about radiation therapy at Siteman.

Medications for pituitary tumors

Pituitary tumors may be treated with medications if they are secreting hormones. A good example of this is prolactin-secreting adenomas, which can be effectively treated with dopamine receptor agonist therapy. Sometimes, patients will receive medication if the entire tumor could not be removed during surgery.

These medications aren’t traditional chemotherapies. They are usually given as injections or pills. They are tailored to the hormones involved.

Medications are also used to treat patients with low hormone levels.

Will my pituitary tumor come back after treatment?

It largely depends on the type of tumor you have. Tumors associated with Cushing’s disease, for instance, have a high rate of recurrence. Other types of pituitary tumor do not.

Regardless of your tumor type, your care team will continue to monitor you in the years following treatment to check for any signs of new tumor growth. If the tumor does return, your team will design a new treatment plan.

What clinical trials does the Pituitary Center offer?

The Washington University Physicians affiliated with the Pituitary Center are working constantly to improve care and outcomes for patients with pituitary tumors. Our investigators are exploring new medical therapies for Cushing’s disease and acromegaly, as well as new approaches to managing complications in surgical patients.

One trial ongoing at the Pituitary Center seeks to prevent hyponatremia, or low blood sodium, in patients who have recently undergone surgery to remove their pituitary tumors. Hyponatremia, when severe, can cause headaches, nausea/vomiting, and seizures. The trial examines whether restricting patients’ fluid intake decreases their chances of developing hyponatremia.