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Tumors in the pituitary gland at the base of the skull can cause serious, life-threatening problems. People who have pituitary tumors often need surgery.

Surgery is usually a very effective treatment for pituitary tumors. Surgeons can often remove all or most of a pituitary tumor and limit its effects.

Pituitary tumor surgery is a delicate process, says Paul Gardner, MD, director, UPMC Center for Skull Base Surgery, and Peter J. Jannetta Endowed Chair of Neurological Surgery, UPMC School of Medicine. Because of the surgery’s complexity, it’s important to seek out a pituitary tumor Center of Excellence for treatment.

“It can make all the difference between an excellent outcome and not having a great outcome,” Dr. Gardner says.

Learn more about pituitary tumors and what pituitary surgery entails.

What Is the Pituitary Gland?

The pituitary gland is a tiny gland that sits at the base of the skull, just below the brain and above the nasal passages. It connects to the hypothalamus of the brain, and the optic nerves for vision are just above it.

“It’s a critical gland,” says Dr. Gardner. “It’s about the size of a chickpea, and it sits really smack in the middle of your head. If your head were the Earth, this gland would be at the core at the center of the Earth.”

The pituitary gland is the body’s “master gland” because it controls hormone secretion throughout your body. It helps regulate your growth and development and helps your organs and other glands function properly.

“For example, it controls your thyroid, it controls lactation in women, and it controls your sexual drive and your sexual organs,” Dr. Gardner says. “It controls your adrenal glands, so adrenaline and cortisol. Of all of these critical structures, from the thyroid on down, the pituitary gland is considered the master gland. It controls all of that.”

What Are Pituitary Tumors?

Pituitary tumors are abnormal growths in the pituitary gland. They are one of the most common skull-base tumors.

Most pituitary tumors are benign — noncancerous — but they can still cause problems. The pituitary gland sits in a small area of the skull called the sella turcica. Because the pituitary gland is in a small area, the tumor grows too large for it and causes problems, Dr. Gardner says.

“The tumor itself just gets too big for the area,” he says.

Pituitary tumor symptoms

The most common symptom of a pituitary tumor is vision loss because the optic nerves are so close to the pituitary gland. A tumor that grows too large can press on the optic nerves, causing peripheral or even complete vision loss.

In other cases, pituitary tumors can affect hormone production or even create extra hormones. This extra production can affect many of your body’s functions and cause a variety of symptoms, including:

• Abnormal growth.
• Abnormal weight gain or weight loss.
• Depression.
• Early menopause.
• Fatigue.
• Fertility problems.
• Galactorrhea (abnormal breast milk production).
• Headaches.
• Impaired sense of smell.
• Impaired sex drive.
• Menstruation problems.
• Muscle/joint pain or weakness.
• Nausea/vomiting.
• Osteoporosis.
• Sexual problems.
• And many more.

Diagnosing pituitary tumors

Pituitary tumors are often difficult to diagnose because their symptoms are similar to those of many other conditions. But vision loss, headaches, and hormonal or metabolic changes are common signs, especially when they occur at the same time.

A magnetic resonance imaging (MRI) scan can help diagnose pituitary tumors.

Pituitary Tumor Treatment

Surgery is typically the first-line treatment for pituitary tumors.

One exception is for prolactinomas, tumors that cause prolactin production, leading to abnormal breast milk flow. This can occur even in people who aren’t pregnant or breastfeeding. Medications are the typical treatment for prolactinomas, which account for about 10% of pituitary tumors.

Otherwise, surgery is the main treatment for a pituitary tumor because of its location and the important things around it, Dr. Gardner says. Radiation is not a primary treatment for pituitary tumors, but it can serve as a supplement to surgery.

Who Is a Candidate for Pituitary Tumor Surgery?

Whether you get pituitary tumor surgery depends on the size of the tumor and the symptoms it’s causing.

“Small tumors do not necessarily require surgery because not all small tumors will grow to a point where they are a problem,” Dr. Gardner says. “I have many patients with smaller tumors, and even older patients with a little bit larger tumors, where I’ll just observe the tumor and make it prove that it needs to have something done.”

Vision loss is usually the top indicator that surgery is necessary, Dr. Gardner says.

Preparing for Pituitary Tumor Surgery

The presurgery process for a pituitary tumor is important to minimize the risks of surgery. At the UPMC Pituitary Tumor Center of Excellence, the process involves specialists from several different disciplines.

The UPMC team checks a patient’s vision and takes a full hormone panel to check whether the tumor is affecting their hormones. They take imaging — including an MRI that uses very fine cuts and can detect tumors that other scans might miss. If surgery is necessary, they also take a computed tomography (CT) scan to see the arteries and the nose’s bone structure.

An anesthesiologist and an otolaryngologist, or ear, nose, and throat (ENT) doctor, also may contribute during the preoperative period, Dr. Gardner says.

“That period of the workup, it’s a little bit intensive,” he says. “But because we have [the expertise] all in one location, we try to plan all of it together.”

Pituitary Tumor Surgery

UPMC pioneered the minimally invasive Endoscopic Endonasal Approach (EEA) for pituitary tumors and other tumors at the base of the skull.

Surgeons like Dr. Gardner and Georgios Zenonos, MD, associate director, UPMC Center for Cranial Base Surgery, operate through the nose and sinuses. This way, they can reach tumors and resect them. They use a specially designed endoscope — a thin tube with a light and camera attached — along with state-of-the-art surgical instruments.

For pituitary tumors at UPMC, a neurosurgeon and ENT surgeon work side by side to remove the tumor and ensure the nose and critical structures remain intact.

“That kind of pilot and copilot concept — I really think it allows us to have better outcomes,” Dr. Gardner says. “Not just for the nose itself, but also for the pituitary gland.”

Depending on the size of the tumor and its location, the procedure can take anywhere from two hours to six hours or longer. Patients generally stay in the hospital for about two days before returning home.

After the procedure, patients will have a follow-up appointment with the ENT surgeon and neurosurgeon a week later. They’ll have another follow-up procedure with the ENT surgeon after about a month, and then they’ll have annual imaging appointments.

Dr. Gardner says patients who live farther away can make follow-up appointments with a more local doctor and connect with UPMC via telemedicine.

“It really fits very well with this idea of trying to bring you in for this specialty care of the surgery,” he says. “But then everything after that, we try to avoid having to make you travel too much but still provide the same care.”

Pituitary Tumor Surgery Prognosis

Most pituitary tumor surgical procedures are successful. Dr. Gardner says in over 90% of cases, surgeons can remove the entire tumor, and there is a low risk of regrowth. In many cases, surgery can also help to control the excess hormones the tumor causes.

For cases in which surgery cannot remove the entire tumor or control all of the excess hormones, radiation or medication may supplement the procedure.

UPMC pioneered the Gamma Knife® radiosurgery technique — becoming the first center in North America to install a Gamma Knife — in 1987. The procedure isn’t actually surgery — it uses individual, precisely focused radiation beams to target tumors.

The Gamma Knife procedure can help control tumors that surgeons cannot completely resect. It is also a possible option for high-risk patients for whom surgery is not an option.

With surgery, plus medication and/or Gamma Knife if necessary, pituitary tumors can almost always be well controlled, Dr. Gardner says.

“We do maximal safe resection, which is usually 100%, but pretty much always at least 90% of the tumor removal,” he says. “And, so, the very small amount of tumor can be treated with a very low dose of radiation technique, called Gamma Knife. [UPMC has] the most updated technology and the most experience possible with it. And as a result of that experience, we have superb outcomes.”

Why Choose UPMC for Pituitary Tumor Surgery?

UPMC Presbyterian received accreditation as a Pituitary Center of Excellence in 2021. To receive and maintain that accreditation, UPMC must meet the criteria for Centers of Excellence. Those standards include a high surgical volume, a multidisciplinary team and approach to care, and leadership in training.

“It requires a level of quality to be both set and maintained, and that’s not an easy thing to do,” Dr. Gardner says. “But I think it guarantees good patient outcomes.”

UPMC is the only Pituitary Center of Excellence in the region. Our multidisciplinary experts have decades of specialty training and experience in caring for patients with pituitary tumors. And we helped to pioneer cutting-edge treatments for pituitary tumors, including the EEA and Gamma Knife radiosurgery.

“Pituitary is the one tumor in the head that’s been proven to do better in centers with experience,” Dr. Gardner says. “It’s critical.”

Most importantly, we treat patients on an individual case-by-case basis. This approach helps ensure that each patient receives the best care for them.

“It needs to be very individualized depending on the person, and the tumor, and what their symptoms are, and what their goals are in life,” Dr. Gardner says. “All those things are very, very important. Even if you don’t come here, I would encourage people who have a pituitary tumor to really seek out a Center of Excellence for this. It is critical for this particular tumor.”

For more on the UPMC Pituitary Center of Excellence, visit our website.