Once diagnosed with Pituitary tumour, we need to find out the extent of the tumour and most importantly the functional state of the Pituitary hormones. Prolactin secreting tumours can be managed by medical therapy. In a significant number of times Pituitary gland does not secrete hormone, so they cause pressure effect on surrounding structures or Hypopituitarism.
When is surgery needed?
Pituitary surgery is required when there is a tumor in the pituitary gland
Secreting excess hormones
Causing compression of adjacent structures like the optic nerve causing the visual disturbance
How do Surgeons approach the Pituitary gland?
There are two approaches that are commonly used:
Transnasal approach: The gland is approached through the nose through the air sinus situated just in front of it. This is most commonly used.
Transcranial approach: The gland is approached through an opening made in the skull
What are the possible complications of surgery?
The complications that can arise after surgery include:
There can be a leak of the brain fluid (Cerebrospinal Fluid – CSF) through the nose after surgery. It is usually transient and settles down soon after surgery.
Diabetes insipidus: The posterior pituitary is responsible for maintenance of water & electrolyte balance in the body. Pituitary operation sometimes causes alteration in the secretion of posterior pituitary hormone.
Hypofunction of Pituitary hormones: If not from before, Hypopituitarism can develop after Pituitary surgery. There is nothing to worry about that we can now very effectively replace the deficient Pituitary hormones.
When is radiotherapy used?
Reduce the size of pituitary tumors
Prevent further growth of pituitary tumours
Post-operatively to markedly decrease the chance of symptomatic tumour recurrence
Reduce excessive hormone secretion (such as growth hormone or ACTH).
Pituitary Tumor Radiotherapy
What are the side effects?
Short term
Hair Loss: Some hair loss occurs at both sideburn areas (temples) temporarily which can be covered by scalp hair
Tiredness: Tiredness during and after treatment is quite normal. A good balance between activity and rest may actually help the feeling of tiredness
Long term
Hypopituitarism
Due to irradiation of hypothalamus leading to decreased releasing hormones
Visual impairment
Other forms of radiotherapy
Local forms of radiotherapy – advantages are that a focused beam on the tumor with minimal damage to adjacent tissue
Gamma knife radiotherapy
The Gamma Knife offers a non-invasive alternative for many patients.
Linear accelearator focal radiotherapy
Radiosurgery can be preformed with linear accelerator machines.
With radiosurgery, the radiation dose given in one session is usually less than the total dose that would be given in radiation therapy.