Pituitary Adenomas: Symptoms, Diagnosis, and Treatment

Pituitary adenomas are tumors that develop in the pituitary gland, a pea-sized gland at the base of the brain that acts as the body’s hormone control center. The great majority are benign (non-cancerous), and many are found incidentally. Because the pituitary gland regulates so many hormones and sits just below the nerves for vision, these tumors can cause a wide range of symptoms — and are very treatable.

Functioning vs. non-functioning tumors

Pituitary adenomas fall into two broad groups:

• Functioning (hormone-secreting) adenomas produce excess hormones, leading to specific syndromes — for example, excess prolactin, growth hormone (acromegaly), or cortisol (Cushing’s disease).
• Non-functioning adenomas do not secrete extra hormones but can cause problems by growing and pressing on nearby structures.

Symptoms

Symptoms come from two sources — hormone changes and pressure from the tumor:

• Hormonal effects: fatigue, unintended weight changes, changes in menstrual periods or sexual function, or symptoms of a specific hormone excess.
• Pressure effects: headaches and vision changes — classically a loss of peripheral (side) vision when the tumor presses on the optic nerves above the gland.

How is it diagnosed?

Evaluation usually includes a dedicated MRI of the pituitary, blood tests to measure hormone levels, and, if vision is affected, formal visual field testing. Care is often coordinated between neurosurgery and endocrinology.

Treatment options

Treatment depends on the tumor’s size, whether it secretes hormones, and whether it is affecting vision:

• Observation. Small, non-functioning tumors that aren’t causing problems can often be monitored with periodic MRIs and hormone testing.
• Medication. Some tumors — prolactinomas in particular — can be controlled with medication alone, often without surgery.
• Surgery. When a tumor threatens vision, secretes excess hormones that can’t be controlled with medication, or continues to grow, surgical removal is highly effective. The modern approach is endoscopic transnasal (transsphenoidal) surgery — the tumor is removed through the nose and sinus, with no incision on the face or head and a relatively quick recovery.
• Radiation therapy may be used for residual or recurrent tumors.

Why the right team matters

Pituitary care benefits from a coordinated team including neurosurgery and endocrinology, so that both the tumor and the body’s hormone balance are managed together. When surgery is needed, experience with endoscopic skull base techniques allows safe, effective removal while protecting the normal gland, the optic nerves, and surrounding structures.

Dr. Arnaout specializes in endoscopic skull base surgery, including transnasal endoscopic pituitary surgery.

When to see a specialist

If you’ve been told you have a pituitary adenoma — or you have unexplained hormonal symptoms or peripheral vision changes — an evaluation by a neurosurgeon experienced in pituitary and skull base surgery can help you understand your options.

To discuss a pituitary adenoma diagnosis or get a second opinion, request an appointment.