Pituitary Tumours and Endoscopic Surgery

What is this condition?

The pituitary is a small gland beneath the brain that coordinates many hormones. Most pituitary tumours are adenomas and are not cancer, but they may produce excess hormone, reduce normal hormone production, or grow upward and compress the optic nerves. Size alone does not decide treatment; hormone activity, vision, growth and tumour anatomy are central.

What symptoms can it cause?

• Loss of side vision, blurred or double vision
• Headache or a sudden severe headache with visual loss
• Menstrual, fertility, sexual-function or milk-discharge changes
• Changes in weight, facial features, hands, blood pressure, glucose, energy or thirst

How is it assessed and diagnosed?

Assessment usually combines pituitary MRI, formal visual-field testing and a carefully selected hormone panel. Prolactin, cortisol, thyroid, growth-hormone and sex-hormone axes may be tested. Very high prolactin can indicate a prolactinoma, but some large tumours mildly elevate prolactin by stalk effect, so interpretation by endocrinology is important.

Treatment without surgery

Many prolactinomas shrink with dopamine-agonist medicine and do not need first-line surgery. Small non-functioning tumours may be monitored. Hormone deficiencies need replacement, and functioning tumours often require coordinated endocrinology care before and after any procedure.

When is surgery or a procedure considered?

Surgery is considered when vision is threatened, a non-prolactinoma functioning tumour needs control, the tumour grows, medication is ineffective or intolerable, or pituitary apoplexy causes acute visual or neurological deterioration. The common route is endoscopic endonasal transsphenoidal surgery through the nostril; some very large or laterally extending tumours need another strategy.

Treatment and procedure options

• Endoscopic endonasal tumour removal
• Medical treatment for prolactinoma and selected hormone problems
• Focused radiotherapy or radiosurgery for selected residual/recurrent tumour
• Long-term MRI, visual and endocrine follow-up

Risks from the disease and from treatment

Progressive compression can permanently damage vision. Hormone excess can injure the heart, bones, metabolism and general health; hormone failure can become life-threatening during illness. Rare pituitary apoplexy is an emergency. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

After endoscopic surgery, the team watches vision, sodium, urine output, cortisol and possible CSF leak. Temporary or permanent diabetes insipidus or hormone replacement may occur. Nasal precautions, endocrine review, pathology and follow-up MRI are part of recovery. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• AANS — Pituitary Gland and Pituitary Tumors: https://www.aans.org/patients/conditions-treatments/pituitary-gland-and-pituitary-tumors/
• Endocrine Society — Pituitary Tumors: https://www.endocrine.org/patient-engagement/endocrine-library/pituitary-tumors