Pituitary tumors are common benign neoplasms that develop in the pituitary gland, accounting for 10-15% of all intracranial tumors. They can lead to various symptoms based on hormone production and pressure effects on surrounding structures, with treatment options including surgery, medication, and radiation therapy. Diagnosis requires a combination of imaging, blood tests to assess hormone levels, and sometimes dynamic function tests.

1. PITUITARY TUMORS

2. OUTLINE
● Introduction
● The Pituitary Gland
● Definition
● Risk factors/Etiology
● Types of Pituitary tumors
● Clinical manifestations
● Investigations
● Treatment
● Conclusion

3. INTRODUCTION
● Pituitary tumors are common neoplasms, and
recognition of their presentation is critical since a
favorable therapeutic outcome is dependent on
early identification of the lesion.
● Pituitary tumors constitute 10-15% of all
diagnosed intracranial tumors, 90% of which are
adenomas.

4. THE PITUITARY GLAND
● The pituitary gland is a small, pea-sized gland located at the base of
the brain, just below the hypothalamus, housed within a bony
structure called the sella turcica ,which is a part of the sphenoid bone
of the skull.
● It is attached to the base of the brain by a stalk, known as the
infundibulum.
● The gland has two parts: the anterior pituitary (adenohypophysis)
and the posterior pituitary (neurohypophysis)
● The inferior border of the pituitary rests on the floor of the sella
turcica, and the superior border is located just under the optic chiasm.
● The cavernous sinus and carotids are found laterally.

5. PITUITARY HORMONES
 Anterior Lobe Hormones:
● Growth Hormone (GH): Stimulates growth, cell reproduction, and
cell regeneration.
● Prolactin (PRL): Promotes lactation (milk production) in
breastfeeding women.
● Adrenocorticotropic Hormone (ACTH): Stimulates the adrenal
glands to produce cortisol.
● Thyroid-Stimulating Hormone (TSH): Stimulates the thyroid gland
to produce thyroid hormones.
● Luteinizing Hormone (LH) and Follicle-Stimulating Hormone
(FSH): Regulate reproductive processes including ovulation and
sperm production.

6. PITUITARY HORMONE
 Posterior Lobe Hormones:
● Oxytocin: Stimulates uterine contractions during
childbirth and milk ejection during breastfeeding.
● Antidiuretic Hormone (ADH) or Vasopressin:
Regulates water balance in the body by controlling the
amount of water reabsorbed by the kidneys.

7. DEFINITION
● A pituitary tumor is an abnormal growth of cells in the
pituitary gland.
● There are five mature pituitary cell types in the anterior
pituitary:
 Somatotrophs (growth hormone, GH)
 Lactotrophs (prolactin, Prl)
 Thyrotrophs (thyrotropin or thyroid stimulating hormone,
TSH)
 Gonadotrophs (gonadotrophins or luteinizing hormone, LH;
and follicle stimulating hormone, FSH)
 Corticotrophs (adrenocorticotrophic hormone, ACTH)

8. ● Tumors that develop in the pituitary gland are usually small,
localized, slow-growing masses that start in one type of hormone-
producing pituitary cells.
● Although these tumors almost always are benign (referred to as
adenomas), they have the potential to cause significant symptoms
by:
○ Producing too much of one of the pituitary hormones
○ Suppressing the normal function of other cells in the pituitary
gland
○ Growing large enough to press on the nearby optic chiasm or on
parts of the brain itself

9. TYPES
● Pituitary Adenomas are characterized by size and by what
hormones, if any, are secreted.
● Based on size;
○ Microadenoma: Less than 1 centimeter (10mm) in
diameter. These are often incidental findings on imaging
tests performed for other reasons and may not cause any
symptoms.
○ Macroadenoma: Larger than 1 centimeter (10mm) in
diameter. These can cause symptoms due to their size and
mass effect on surrounding structures.

10. TYPES
● Based on Hormonal activity;
 Functioning (hormone secreting) Adenomas: These tumors produce
an excess of one or more hormones, leading to a specific set of
symptoms depending on the hormone affected. Examples includes;
 ACTH-producing tumor
 Prolactin-producing tumor
 Growth hormone-producing tumor
 TSH-producing tumor
 Non-Functioning Adenomas: These tumors do not produce excess
hormones and may not cause any symptoms until they become large
enough to press on nearby structures.

11. ETIOLOGY
● The exact cause of most pituitary tumors remains
unknown. However some risk factors involved include:
 Genetic factors such as somatic mutation and genetic
mutation.
 Certain hereditary conditions such as Multiple Endocrine
Neoplasia Type 1 (MEN1).

12. ACTH-PRODUCING ADENOMA
● This pituitary tumor, which also is called a basophilic
adrenocorticotrophic hormone-secreting adenoma,
overproduces adrenocorticotrophic hormone (ACTH).
● ACTH is the pituitary hormone that regulates hormone
production by the adrenal gland.
● This type of pituitary tumor releases too much ACTH into the
bloodstream, the extra ACTH overstimulates the adrenal
glands to pour out high levels of adrenal glucocorticoids
(adrenal hormones) and androgens (male hormones) into the
blood.
● In most cases, an ACTH-producing tumor is small and doesn't
grow beyond the sella turcica.

13. Symptoms
This tumor causes symptoms of Cushing's disease, a condition caused by
prolonged overproduction of adrenal glucocorticoids and androgens.
These includes;
■ trunal obesity
■ thin skin,
■ easy bruising,
■ red or purple lines (striae) on the skin of the abdomen,
■ a moon-shaped face,
■ muscle wasting,
■ excess body hair in women,
■ acne,
■ amenorrhea
■ psychiatric symptoms, such as depression and psychosis.
■ Cushing's disease also can trigger osteoporosis, hypertension and

14. Treatment
● Transsphenoidal hypophysectomy: In this procedure, the surgeon removes
the pituitary tumor through an incision in the upper portion of the nasal
passages.
○ After surgery, levels of glucocorticoid hormones are abnormally low,
so the patient typically needs to take supplemental glucocorticoid
medication for about 3 to 12 months.
○ This medication gradually is tapered as the body slowly reestablishes a
normal working relationship between the pituitary gland and the
adrenal glands.
○ If the tumor cannot be completely removed by surgery, radiation
therapy may be needed.

15. PROLACTIN PRODUCING TUMOR
● This prolactin-secreting adenoma (prolactinoma)
overproduces the hormone prolactin, which stimulates the
breasts to make milk.
● Prolactin-producing pituitary tumors can develop in both
men and women.

16. Symptoms
● Galactorrhea: Flow of breast milk in a woman
who is not pregnant or breast-feeding.
● Less frequent or no menstrual periods
(amenorrhea)
● Trouble becoming pregnant or an inability to
become pregnant (infertility).
● In men, it causes decreased libido and erectile
dysfunction in men

17. Treatment
● Treatment is determined by the size of the tumor and how
much prolactin is being produced.
● Small tumors sometimes don't need to be treated and can
be monitored to see if they change.
● If treatment is necessary, one of the drugs (long-acting
dopamine agonists) can be used:
■ Bromocriptine (Parlodel),
■ Pergolide (Permax) or
■ Cabergoline (Dostinex).
● These drugs reduce blood levels of prolactin and often
shrink the size of the pituitary tumor.

18. Treatment
● If a prolactinoma is large or produces high levels
of prolactin, surgery may be recommended.
● Surgery also may be needed if medications don't
help or the person can't take the medications long
term because of side effects.
● When surgery is needed, the tumor is removed
with a procedure called transsphenoidal
hypophysectomy.
● In rare cases, radiation therapy may be needed.

19. GROWTH HORMONE PRODUCING
TUMOR
● This tumor, also is called an eosinophilic growth
hormone-secreting adenoma, secretes abnormally
large amounts of growth hormone.
● In children and teenagers, this overproduction of
growth hormone causes a condition called giantism .
● In adults, it causes a condition called acromegaly
(abnormal enlargement of the skull, jaw, hands and
feet, and other symptoms of abnormal growth).
● Growth hormone-producing tumors can grow beyond
the sella turcica.

20. Symptoms
● If this tumor develops before puberty, then the child
typically has the following symptoms of giantism (also
called gigantism):
■ abnormally rapid growth,
■ unusually tall stature,
■ a very large head,
■ coarse facial features,
■ very large hands and feet,
■ and sometimes, behavioral and visual problems.

21. Symptoms
● If the tumor develops after puberty, then the person has the following
symptoms of acromegaly:
 thick, oily skin
 coarse features with thick lips and a broad nose
 prominent cheekbones
 a protruding forehead and lower jaw
 a deep voice
 enlargement of the hands and feet
 a barrel-shaped chest
 excessive sweating
 and pain and stiffness in the joints.

22. Treatment
● Transsphenoidal hypophysectomy is usually the
first choice, often followed by medical therapy
with a somatostatin analog to control symptoms.
● Radiation therapy is used in people who do not
respond to surgery or medication.

23. TSH PRODUCING TUMOR
● TSH-producing pituitary tumors, also known as TSHomas,
are abnormal growths of cells in the pituitary gland that
secrete thyroid-stimulating hormone (TSH). TSH plays a
crucial role in regulating the function of the thyroid gland,
which is essential for maintaining metabolism, growth, and
development.
● This unregulated production of TSH stimulates the thyroid
gland to produce excessive thyroid hormones (T3 and T4).
● Elevated levels of T3 and T4 result in clinical
hyperthyroidism, which includes a wide range of symptoms
and systemic effects.

24. Symptoms
● Patients with TSHomas may present with symptoms
typical of hyperthyroidism, such as:
○ Weight loss despite normal or increased appetite
○ Heat intolerance and sweating
○ Palpitations and tachycardia
○ Nervousness, anxiety, and irritability
○ Tremors
○ Fatigue and muscle weakness
○ Menstrual irregularities in women

25. Treatment
● Transsphenoidal hypophysectomy can be remove the
tumor through the nose and sphenoid bone. This is often
the first-line treatment for TSHomas.
● Medications: Somatostatin analogs are medications that
can shrink the tumor and decrease TSH production. They
may be used alone or in combination with other therapies.
Antithyroid medications are also given to control
hyperthyroidism symptoms
● Radiation therapy may be used to destroy tumor cells,
particularly for recurrent or inoperable tumors.

26. NON FUNCTIONING PITUITARY
ADENOMA
● This type of pituitary tumor is an hormonally inactive adenoma.
● It is slow to produce symptoms. For this reason, this type of tumor
tends to grow large before it is discovered.
● In many cases, a nonfunctioning pituitary adenoma is diagnosed
only when it already has grown beyond the sella turcica and has
begun to cause problems related to pressure on the optic nerves or
brain and affects the production of other pituitary hormones causing
hypopituitarism.
● Typically present with symptoms related to their size and pressure
effects on surrounding structures, rather than hormone excess.

27. Symptoms
● Headache due to direct pressure on pain-sensitive structures in the brain.
● Hypopituitary symptoms such as
○ Adrenal Insufficiency (Low ACTH): Symptoms include fatigue, weakness,
weight loss, low blood pressure, and salt craving.
○ Hypothyroidism (Low TSH): Symptoms include fatigue, weight gain, cold
intolerance, constipation, dry skin, and hair loss.
○ Gonadal Dysfunction (Low LH/FSH): In women, this can cause menstrual
irregularities or amenorrhea (absence of menstrual periods), infertility, and
decreased libido. In men, it can lead to decreased libido, erectile dysfunction,
and infertility.
○ Growth Hormone Deficiency: In adults, this can cause increased fat mass,
decreased muscle mass, and reduced energy. In children, it can lead to growth
failure and short stature.

28. Symptoms
● They can have symptom related to pressure on the optic chiam
such as:
○ Bitemporal Hemianopsia: Loss of peripheral vision in both
eyes, often caused by compression of the optic chiasm, which
lies just above the pituitary gland.
○ Reduced Visual Acuity: Blurred vision or difficulty seeing,
which may progress over time if the tumor continues to grow.
○ Double Vision (Diplopia): If the tumor affects cranial nerves
that control eye movement (cranial nerves III, IV, and VI).

29. Treatment
● Many do not treat nonfunctioning pituitary tumors if the tumor is less
than 10 millimeters in diameter. Instead, they monitor the growth of
the tumor with periodic MRI scans.
● Larger tumors are removed surgically using a transsphenoidal
hypophysectomy, sometimes followed by radiation therapy to
eliminate any remaining tumor.
○ However, not all pituitary tumors can be removed by using this
surgical approach, either because the tumor is too large or
because it is in a position that is difficult to reach through the
nose. Instead, the surgeon must do a procedure called a
craniotomy, which removes the tumor through an incision in the
front portion of the skull.

30. Other general signs and symptoms of pituitary
tumors:
● Headache
● Nausea and Vomiting
● Confusion.
● Dizziness.
● Seizures.
● Runny or "drippy" nose (cerebrospinal fluid that
surrounds the brain and spinal cord leaks into the
nose).

31. INVESTIGATIONS
● Thorough Medical History and Physical Examination
● Magnetic Resonance Imaging (MRI) is the gold standard for visualizing pituitary
tumors due to its superior soft-tissue contrast. (CT scans may be used if MRI is
contraindicated or unavailable).
● Blood tests are crucial for assessing hormone levels produced by the pituitary
gland and other glands it regulates.These includes:
○ Thyroid function test to evaluate thyroid function.
○ ACTH and cortisol: To assess adrenal function.
○ Prolactin: To assess milk production and fertility.
○ Growth hormone (GH) and insulin-like growth factor 1 (IGF-1)
● Dynamic funtion tests such as OGTT, Dexamethasone Suppression Test can also
be done to further confirm diagnosis.

32. COMPLICATIONS
● One of the most significant complications is compression of the optic chiasm, which
is located just above the sella turcica. This can lead to:
○ Visual Field Defects: Commonly, patients may experience bitemporal
hemianopsia, which is the loss of peripheral vision in both eyes.
○ Vision Loss: Severe compression can lead to progressive vision loss and, if
untreated, potentially blindness.
○ Growth beyond the sella turcica can affect nearby cranial nerves.
● Larger tumors may compress parts of the brain, leading to:
○ Headaches: Often due to increased intracranial pressure or direct pressure on
pain-sensitive structures.
○ Cognitive Changes: Memory problems, personality changes, or other cognitive
disturbances if the frontal lobes or other brain regions are affected.
● Hypopituitarism: Tumor growth can compress normal pituitary tissue, leading to
decreased production of one or more pituitary hormones.

33. CONCLUSION
● Pituitary tumors are abnormal growths in the pituitary gland, a pea-
sized gland at the base of the brain responsible for hormone
production.
● Most pituitary tumors are benign (noncancerous) and can cause
symptoms due to hormone imbalances or pressure on nearby
structures.
● Symptoms vary depending on the type of hormone affected but can
include vision changes, headaches, fatigue, and changes in weight
or physical appearance.
● Diagnosis involves a combination of blood tests to assess hormone
levels, imaging tests to visualize the pituitary gland, and sometimes
additional tests to evaluate pituitary function.

34. QUESTIONS
1. The pituitary gland is housed within which bony structure?
A. Skull cap B. Sphenoid bone
C. Temporal bone D. Frontal bone
2. Which hormone is NOT produced by the anterior pituitary?
A. Growth Hormone (GH) B. Prolactin (PRL)
C. Adrenocorticotropic Hormone (ACTH) D. Oxytocin
3. Which symptom is associated with TSH-producing tumors?
A. Weight gain B. Cold intolerance
C. Palpitations D. Reduced sweating
4. What is the most common surgical procedure for removing pituitary tumors?
A. Craniotomy B. Transsphenoidal hypophysectomy
C. Gamma knife surgery D. Endoscopic third ventriculostomy

35. QUESTIONS
5. What is a pituitary microadenoma?
A. Tumor larger than 1 cm in diameter B. Tumor less than 1 cm in diameter
C. Non-functioning adenoma D. ACTH-producing tumor
6. Which hereditary condition is associated with a higher risk of pituitary tumors?
A. Diabetes B. Multiple Endocrine Neoplasia Type 1 (MEN1)
C. Hypertension D. Osteoporosis
7. What is the gold standard imaging technique for visualizing pituitary tumors?
A. CT scan B. MRI
C. X-ray D. Ultrasound
8. Which condition is caused by excessive production of growth hormone in adults?
A. Acromegaly B. Gigantism
C. Cushing's syndrome D. Hyperthyroidism

36. QUESTIONS
9. Which dynamic test is used to diagnose acromegaly?
A. Oral Glucose Tolerance Test (OGTT)
B. Dexamethasone Suppression Test
C. Water deprivation test
D. ACTH stimulation test
10. Which visual field defect is commonly caused by pituitary tumors?
A. Central scotoma
B. Bitemporal hemianopsia
C. Homonymous hemianopsia
D. Quadrantanopia