Pituitary Tumor - Procedures, Side effects, Recovery time, Costs and alternatives

Abnormal growth of cells is called a tumor that can start anywhere in the body. Tumors that arise in ‎the pituitary is called a pituitary tumor. The pituitary is a small gland present inside the skull and it ‎sits in a tiny bony space called the “sella turcica”. Optic nerves are connecting the eyes to the brain, ‎pass close to it.‎ Mostly all pituitary tumors are non-cancerous glandular tumors called “Pituitary adenomas”. These ‎are called benign as they don’t spread to other parts of the body like cancer. Still, it might cause other ‎major health problems since they are close to the brain and they may invade to nearby tissues like ‎sinuses or skull.‎

In the skull, the tumors have a little space to grow. Some pituitary tumors result in too many of the hormones that regulate important functions of your body. Some pituitary tumors can cause your pituitary gland to produce lower levels of hormones. So, when the tumor gets larger over half an inch, it ‎may grow upward and press the nearby parts of the brain, nerves thus damage them which can lead to ‎problems such as headaches or vision changes.‎ Generally, after the patient diagnosed with a pituitary tumor, drugs, radiotherapy, surgery, and ‎Hormone replacement therapy will be recommended based on the tumor’s level of growth and the ‎patient’s physical condition.‎

Most of the pituitary tumors don’t need treatment. However, treatment depends on the tumor size ‎and its growth speed. Age and overall health factors are also considered for the treatment.‎ A team of medical experts including a neurosurgeon, endocrinologist, and a radiation oncologist ‎involved in the treatment for a pituitary tumor. Depends upon the tumor’s growth, the patient is ‎provided with single or integrated treatment.‎

1. Drugs:‎
   • Pituitary tumor with medications may aid to block excessive hormone secretion and ‎sometimes it may shrink certain pituitary tumor types. Some medications help when pituitary ‎tumor produces excessive hormones. Drugs such as Cabergoline, bromocriptine help in ‎treating tumors that secrete prolactin. Pegvisomant and Octretide are used for tumors that ‎help in hormone growth.‎
   • ACTH-producing tumors (Cushing syndrome)‎ Mifepristone is administered for people with Cushing syndrome along with type 2 diabetes or ‎glucose intolerance. The drug will not decrease Cortisol production but it blocks the Cortisol ‎effects on the tissues. Pasireotide is the latest drug for Cushing Syndrome and it reduces ‎ACTH production from a pituitary tumor. It is given in injectable form for two times daily. ‎When the pituitary surgery is unsuccessful or cannot be done for a patient, this injection is ‎recommended. ‎
2. • Radiation therapy: In radiation therapy, high-energy sources of radiation is used to destroy tumors. ‎This treatment can be administered alone or along with surgery. When a tumor persists or comes back ‎after surgery, then in such cases radiation therapy might be much beneficial. Some radiation therapy ‎methods are:‎
   • Intensity-modulated radiation therapy (IMRT): In this method, a computer is used by the ‎doctor to shape the beams and surround the tumor from many different angles. In order to ‎receive less radiation, the beam strength can be limited accordingly.‎
   • Proton beam therapy: In this therapy, positively charged ions are used rather than X-rays. ‎Proton beams stop after releasing their power within the target. The beams are finely ‎controlled and can be used on tumors with less health risks. This therapy requires special ‎equipment and it is not widely available.
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3. • Surgery :‎ During an operation, healthy tissue around the tumor and tumor are removed. This is the most ‎common treatment for a pituitary gland tumor. This surgery is performed by a neurosurgeon. ‎Through Transsphenoidal route, about 95% of surgeries are done. The neurosurgeon goes through ‎the nasal passage and along the septum and then he goes through the sphenoid sinus cavity. The rest ‎procedure is done through a craniotomy. This procedure is done using an endoscope or microscope ‎which is a long flexible tube to view the tumor. Both methods are equally safe when it is done by an ‎experienced neurosurgeon.‎
4. Hormone replacement therapy :‎
   • Sometimes the gland will not make enough hormones due to the disease in which case HRT is ‎advised to the patients with a pituitary tumor. The patient is administered with a replacement pill ‎regularly It may include thyroid hormones, adrenal hormone, testosterone, estrogen and growth ‎hormone replacement. ‎

Surgery:Patients who have a tumor with utmost 10 mm in diameter, a tumor which is not close to ‎the key parts of the brain, a Growth Hormone level below 45 ng/mL

HRT: Patients who have lost bone mass and are not benefited from other treatments and stopped ‎having periods before 40 years.‎

Surgery: Patients with diabetes insipidus, severe bleeding, visual problems and meningitis are not ‎suitable for the pituitary tumor surgery.‎

HRT should not be recommended to the patients who suffer from blood clots, heart disease, severe ‎migraines, breast, endometrial and ovarian cancer, stroke, uncontrolled high blood pressure.‎

Some of the associated side effects of the treatment are as follows:

• Hormone replacement therapy :‎ Hormone replacement therapy causes nausea, vaginal bleeding, headaches, mood swings, bloating, breast swelling or tenderness, ‎fluid retention, increased urination and acne commonly.‎
• Surgery :‎ Pituitary tumor surgery side effects are uncommon. But, still there may some problems occur such as ‎damage to large arteries, to nearby tissues of brain, nearby nerves to the pituitary. In a rare case, these ‎can cause a stroke, blindness or brain damage. In rare cases, the brain membranes, meninges may get ‎infected which is called meningitis. Other side effects are diabetes insipidus, congestion, and ‎headaches.‎
• Radiation therapy: ‎ Loss of normal pituitary function which may occur within a year or two after the treatment. ‎Conventional radiation therapy develops a deficiency in pituitary hormones within some years of ‎treatment among 50% of the patient. Vision damage is the uncommon side effect. ‎
  • Drugs :‎ Cabergoline: Nausea, Vomiting, dizziness, spinning sensation, nervousness, tiredness, stomach upset, ‎dry mouth, numbness are some of the common side effects whereas vision changes, edema, persistent ‎cough, shortness of breath are noted as rare side effects.‎
  • Bromocriptine: Depression, insomnia, loss of appetite, drowsiness, stuffy nose, cold feeling, dry ‎mouth are common side effects and painful breathing, back pain, chest pain, running nose, ‎hallucinations, bloody stools are some of the rare side effects.‎
  • Pasireotide: Headache, hair loss, pain and itching in the injected site, rapid weight gain, nausea and ‎stomach pain are the common side effects. Fast or slow heartbeats, slurred speech, light-headed, ‎increased urination, bloating and heartburn are very rare side effects.‎

  In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

Radiotherapy: Avoidance of alcohol, coffee, acidic foods will help in decreasing GI related issues and ‎follow-ups with your oncologist. ‎

Surgery: There are many endocrine, surgical, metabolic disorders have to be monitored after the ‎pituitary tumor surgery. A multidisciplinary team approach is essential for the patient. These patients ‎need life-long observation to ensure balanced hormonal management and monitor for tumor ‎recurrence.‎

Drugs: Tumor medicines may cause adverse and serious side effects some patients. They should ‎consult the doctor immediately after experiencing such side effects.‎

Radiation Therapy: At least a month’s time will take for recovery

Surgery: At least 3 months will take for a gradual recovery

Drugs: You may recover from the side effects after stopping the medicines

The price of the treatment varies from one place to place. The Radiation therapy costs: The cost varies for every procedure, cycle or technique. Approximately it starts ‎from 30,000 INR

Surgery: At a minimum of 3,50,000/- is charged for Pituitary tumor surgery ‎

Hormone replacement therapy: Approximately it starts from 40,000‎ INR.

Surgery: The results may be permanent until it relapses.

HRT: Alternative medicines like homeopathy, acupressure, and acupuncture. Complementary therapy ‎like aroma therapy along with HRT, non-hormonal medical treatment such as anti-depressant drugs ‎and herbal medicines say evening primrose oil.

Radiation therapy: Surgery, chemotherapy, Immunotherapy, Medication to hormones, and ‎Brachytherapy are some of the alternatives to radiation therapy.‎