A pituitary tumour is an abnormal growth found in the pituitary gland. Also known as the hypophysis, the pituitary gland is part of the endocrine system located at the base of the brain.
The pituitary gland's function is pertinent in creating vital hormones for the body and instructing other glands to release hormones. When a pituitary tumour occurs in the human body, hormone regulation is disrupted.
Pituitary tumours can be classified into three groups:
Benign pituitary adenomas: non-cancerous tumours (benign) that do not spread to other areas but grow in size.
Invasive pituitary adenomas: benign tumours with the likelihood of spreading to bones of the skull or the sinus cavity below the pituitary gland.
Pituitary carcinomas: cancerous tumours that are significantly rare and tend to spread into other areas of the central nervous system (brain and spinal cord) or outside of the central nervous system.
Pituitary tumour disrupts the various hormonal regulatory roles of the pituitary gland.
On top of the classifications above, pituitary tumours can be further broken down into types of pituitary tumours:
Functioning adenomas: tumours with the tendency to overproduce some hormones; these tumours are:
Prolactin-producing tumours (prolactinomas): a common and benign tumour that results in an overproduction of prolactin known as hyperprolactinemia.
ACTH-producing tumours: these forms of tumour tend to result in the overproduction of glucocorticoids, resulting in conditions such as immunosuppression and muscle atrophy.
Growth hormone-producing tumours: excess growth hormones lead to gigantism in children or acromegaly in adults.
Nonfunctional adenomas (null cell adenomas): the most common form of pituitary tumour and tend to be asymptomatic until they are much larger. They do not produce any specific hormone, and the symptoms are affiliated with the growth of the tumour and the subsequent pressure induced in the brain.
Macroadenomas: large tumours at over 1 cm and may be functioning or non-functioning.
Microadenomas: smaller tumours below 1 cm in size and may also be functioning or nonfunctioning.
What causes Pituitary Tumours?
Tumours are a result of uncontrollable cell growth in the pituitary gland. The exact cause of this growth is ambiguous. Certain genetic conditions may make one more prone to pituitary tumours, though these tend to be rare.
What are the symptoms of Pituitary Tumours?
Depending on the classification of the pituitary tumours and their specific type, the symptoms exhibited may vary. Additionally, most patients do not exhibit symptoms and are usually only diagnosed when investigating other health issues.
Are Pituitary Tumours painful?
Typically, two groups of symptoms may manifest: those affiliated with tumour pressure and those caused by hormonal changes. Additionally, in cases where hormonal changes are exhibited, they tend to exhibit different symptoms among men and women. Some general signs you may look out for include:
Persistent headache
Impacted vision
Nausea and vomiting
Facial pains
Seizures
Comparison between a healthy pituitary gland and a pituitary gland with a tumour
Some symptoms that may affect both genders include:
Low sex drive (loss of libido)
Fertility problems
Weight gain or loss
Changes in facial features such as enlarged lips, nose, tongue and jaw and growth in hands and feet (acromegaly)
Thicker skin
More sweating and body odour
Joint pain from body growth
Physical changes that may be exhibited with pituitary tumours.
Are Pituitary Tumours painful?
Pituitary tumours can be painful, and the symptoms of pain are usually affiliated with the pressure of tumour growth. These would manifest as facial pains around the temple and sinus areas. Where hormonal imbalances occur, excessive growth in an individual can cause joint pains akin to “growing pains” among children and adolescents during a growth spurt.
Who is at risk of Pituitary Tumours in Singapore?
Given that the exact cause of pituitary tumour growth is unknown, there is no specific risk factor that may increase the likelihood of growth. However, some genetic mutations may result in pituitary tumour growth. These are:
Multiple endocrine neoplasia type 1 and 4:MEN 1, originally known as Wermer syndrome, and MEN 4 is a type of germline mutation inherited from sperm and eggs during conception.
Carney complex (CNC): a rare neoplasia and lentiginosis syndrome predisposed to various cancers.
Headaches, facial pains and nausea are general symptoms of pituitary tumours
How are Pituitary Tumours diagnosed in Singapore?
Given the array of symptom presentations, diagnosing pituitary tumours can be delayed if not examined by a neurosurgeon (link to about us page). The diagnostic methods involved include:
Medical review: symptoms, family history, and risk factors are evaluated in the initial stages of diagnosis.
Blood tests: will reveal elevated growth hormone or other abnormalities that warrant further investigation. This would include a blood chemistry study and venous sampling.
Vision tests: will be conducted to determine if the tumour affects one’s vision, given that the pituitary gland is close to the eye.
Imaging tests: often when a definitive diagnosis is made. This includes computed tomography scans (CT scans) (link to service page), and magnetic resonance imaging (MRIs) (link to service page) will be requested to determine the size, location, and possibility of increased pressure in the brain.
Biopsy: will be conducted to determine the exact type of pituitary tumour and to rule out the possibility of cancer.
What are the treatment options for Pituitary Tumours in Singapore?
Upon diagnosis, below are some treatment paths that may be suggested to reduce symptoms presented by pituitary tumours:
Surgery: is often recommended to remove pituitary tumours. Often, transsphenoidal surgery is conducted to remove tumours through the nasal passage.
Radiotherapy: radiation (also known as gamma rays) therapy may be administered to kill tumour cells if surgery is deemed unsuitable or insufficient.
Drug therapy: would be explored to control functioning pituitary tumours from producing excessive hormones.
Chemotherapy: if a pituitary tumour is malignant, chemotherapy will be administered to kill cancer cells and reduce the likelihood of metastasis.
Combination of treatment modes: a combination of two or more treatment methods may be utilised if necessary. This may vary depending on the subjective condition of each patient.
Frequently asked questions
Can pituitary tumours return?
Depending on the type of pituitary tumour, the rate of recurrence differs. Non-functioning pituitary adenoma, which happens to be the most common form of pituitary tumour, occurs between one and five years after surgery and with a reduced recurrence rate after ten years. Working collaboratively with your neurosurgeon post-treatment is essential to ensure recurrence is identified at early stages.
Can a pituitary tumour shrink on its own?
Some non-functioning tumours can shrink (10%), also known as regression. However, 50% of all cases tend to progress (or worsen). A “wait and see” approach may be initially taken to monitor the growth of your pituitary tumour growth before suggesting any invasive treatments. If the growth is showing symptoms of vision deterioration, it is common for treatment to be administered promptly to preserve bodily functions.
