What it is
The pituitary gland sits at the base of the skull in a bony saddle called the sella turcica. Pituitary adenomas are benign tumors that arise from this gland and are divided into two broad types: functional (hormone-secreting) and non-functional (not secreting active hormone).
Functional tumors cause symptoms based on which hormone they overproduce — prolactin, growth hormone, ACTH (Cushing disease), TSH, or others. Non-functional adenomas typically present when they grow large enough to compress the optic nerves or chiasm (causing visual field loss) or the rest of the pituitary (causing hypopituitarism).
Medical versus surgical management
Not all pituitary adenomas require surgery. Prolactinomas — the most common type — often respond well to dopamine agonist medications and never need an operation. Endocrinology is a critical partner in the evaluation of any functional tumor.
Surgery is indicated when:
- The tumor is compressing the optic apparatus and threatening vision
- Medical therapy has failed or is not tolerated
- The tumor is rapidly growing
- The diagnosis is uncertain and tissue is needed
Surgical approach
Most pituitary tumors are removed through an endonasal transsphenoidal approach — entirely through the nose, with no external incision and no brain retraction. This approach is well-tolerated and allows direct access to the sella. For larger tumors extending significantly into the cranial cavity, a craniotomy may be needed.
Multidisciplinary management — with endocrinology, ophthalmology for visual field monitoring, and radiation oncology for tumors with atypical behavior — is the standard of care.