Pituitary tumors - Diagnosis and treatment

The article was written by MSc Nguyen Thi Ngoc - General Internal Medicine - Endocrinology, Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital.

Many people with normal functioning pituitary tumors do not need treatment if the tumor is not causing other problems. If you are young, careful tumor monitoring is the method of choice that lasts until the tumor is large and requires treatment.

A pituitary tumor is often underdiagnosed because its symptoms are similar to those of other medical conditions. Some pituitary tumors are discovered during tests for other conditions.
To confirm a pituitary tumor, the doctor needs to take a detailed history, perform a physical exam and order:
Blood and urine tests: to determine whether there is a deficiency or overproduction of hormones CT or MRI Brain : assess pituitary tumor location and size Vision exam: determine if tumor is damaging vision or visual field In addition, intensive endocrine testing may be needed.

There are many pituitary tumors that do not require treatment. Treatment depends on the type, size and growth of the tumor in the brain, in addition to age and general health.
Treatment requires a team of specialists such as brain surgeons (neurosurgery), endocrinologists, radiation oncologists. Doctors often use surgery, radiation therapy, and drugs, either alone or in combination, to treat pituitary tumors and return hormone levels to normal.
2.1 Surgery Surgery to remove a pituitary tumor is needed if the tumor is pressing on the optic nerve or causing too much hormone production. The success of surgery depends on the tumor type, tumor location, tumor size, and whether the tumor has invaded surrounding tissue. There are two main surgical techniques to treat pituitary tumors:
2.1.1 Endoscopic transnasal transsphenoidal approach This is a technique to remove the tumor through the nasal passages and sinuses. There is no incision outside the skull. Other parts of the brain were not damaged and there were no scars on the skull. However, large tumors can be difficult to remove with this method, especially when the tumor has invaded the nerves and brain tissue surrounding the tumor.
2.1.2 Craniotomy The tumor is removed through the upper part of the skull through an incision from the scalp. This surgery is applied to large tumors or tumors with many complications.

Radiation therapy uses high-energy radiation to destroy tumors. It can be used after surgery or used as monotherapy if surgery is not an option.
Radiation therapy can be useful in cases where the tumor has appeared or recurred after surgery and causes symptoms that cannot be resolved by medical treatment. Radiotherapy methods include:
3.1 Radiosurgery (Stereotactic radiosurgery) Non-invasive radiation surgery without open surgery, using radiation beam to focus on the tumor. High-dose radiation beam is emitted to fit the size and shape of the tumor under the guidance of special brain imaging techniques.
The minimum dose of radiation reaching healthy brain tissue around the tumor reduces the risk of damaging healthy brain tissue near the tumor.
3.1.1 External beam radiation Small doses of radiation from outside the body that are gradually increased over time, usually 5 days a week for 4-6 weeks as an outpatient. This therapy is often effective, but it takes years to fully control tumor growth and hormone secretion. This therapy can also damage healthy pituitary cells or the healthy brain tissue surrounding the pituitary gland.
3.1.2 Intensity modulated radiation therapy (IMRT) This radiation therapy uses a computer that allows the doctor to adjust the shape of the radiation beam and surround the tumor from many different angles. The strength of the radiation beam is limited, so the surrounding tissues are less affected by radiation.
3.1.3 Proton beam therapy This is radiation therapy that uses protons instead of X-rays. Unlike X-rays, proton beams stop after releasing energy in the target tissue. Proton beams control the tumor with little effect on surrounding healthy tissue. This therapy requires special equipment and is not common in many places.
The benefits and complications of these types of radiation therapy are often not apparent immediately and may take months to years to fully manifest. A radiation oncologist will evaluate your condition and discuss the advantages and disadvantages of each approach with you before choosing treatment.

Medical treatment can help stop hormone overproduction and sometimes can shrink many types of pituitary tumors:
4.1 Prolactin-secreting tumors (prolactinomas) Cabergoline and bromocriptine (Parlodel) decrease prolactin secretion and usually reduced tumor size. Side effects may include: drowsiness, dizziness, nausea, stuffy nose, vomiting, diarrhea or constipation, confusion, and depression. Some patients may develop compulsive behavior disorders, such as gambling addiction, while taking these drugs.
4.1.1 ACTH-secreting tumors (Cushing's syndrome) Mifepristone (Korlym, Mifeprex) has been approved for Cushing syndrome patients with type 2 diabetes or impaired glucose tolerance Mifepristone does not decrease cortisol production but blocks these The effect of cortisol on the body's organs Side effects of the drug can include: fatigue, vomiting, nausea, headache, muscle pain, increased blood pressure, hypokalemia and edema. Cushing's symptom is pasireotide (Signifor), which reduces the production of ACTH by the pituitary gland.
This drug is given by injection twice a day. It is recommended for use in cases where pituitary surgery is unsuccessful or cannot be performed. Side effects are usually mild, and can include: diarrhea, nausea, increased blood sugar, headache, abdominal pain and fatigue
4.1.2 Growth hormone (GH) secretory tumor There are two types of drugs that can can be used for these types of pituitary tumors, especially useful in situations where pituitary surgery has failed to normalize GH levels. g. The first is somatostatine analogs, which include drugs such as octreotide (Sandostatin) and lanreotide (Somatuline Depot) that lower GH levels and can shrink tumors. These drugs are usually given every 4 weeks.
These drugs can cause side effects such as nausea, vomiting, diarrhea, stomach pain, dizziness, headache, and pain at the injection site. Many of these side effects improve or even go away with time. The drug can also cause gallstones and worsen diabetes.
The second drug, pegvisomant (somavert), blocks the effects caused by excessive GH levels on the body. The drug is given as a daily injection, but can cause liver damage in some patients.

If the pituitary tumor or surgical removal of the pituitary gland causes decreased hormone production, you may need hormone replacement therapy to keep hormone levels normal. Some patients receiving radiation therapy also need hormone replacement therapy.

In the meantime, before making a decision to treat or delay treatment, you can continue to monitor the test to determine if the tumor is growing. This may be an option if the tumor is causing no symptoms.
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, modern equipment and technology, but also stands out for its examination and consultation services. comprehensive and professional medical consultation and treatment; civilized, polite, safe and sterile medical examination and treatment space. Customers when choosing to perform tests here can be completely assured of the accuracy of test results.

In April & May 2021, when there is a need for examination and treatment of pituitary tumor at Vinmec Central Park International General Hospital, customers will enjoy double incentives:
- Free specialist examination
- 50% discount for customers with post-examination treatment indications. The program is limited to the corresponding technique of each hospital and to customers who perform this treatment technique for the first time at Vinmec.