The pituitary is a pea-sized gland at the base of the brain that controls the thyroid, adrenals, ovaries or testes, growth and water balance. Pituitary diseases are mostly benign tumours called adenomas, which either make too much of a hormone or press on the gland and nearby nerves.
Many small adenomas are found by chance on brain scans and never cause harm. Problems arise from hormone excess, from hormone deficiency (hypopituitarism) or from pressure on the optic nerves that sit directly above the gland.
Symptoms
- Headaches and loss of side vision
- Irregular or absent periods, milky breast discharge, low libido or erectile problems (raised prolactin)
- Enlarging hands, feet and jaw, sweating and snoring (acromegaly)
- Weight gain around the trunk, purple stretch marks, easy bruising and muscle weakness (Cushing's disease)
- Tiredness, low blood pressure, feeling cold and loss of body hair (hormone deficiency)
- Extreme thirst and passing large volumes of urine (arginine vasopressin deficiency, formerly diabetes insipidus)
- Slow growth or delayed puberty in children
Causes and risk factors
The great majority are adenomas, benign growths of pituitary cells whose cause is unknown; a small number run in families, for example in MEN 1. Prolactinomas are the most common hormone-producing type, followed by non-functioning adenomas, then growth hormone and ACTH-producing tumours. Other causes are craniopharyngiomas and cysts, inflammation of the gland (including as a side effect of cancer immunotherapy), head injury, radiotherapy, severe bleeding at childbirth (Sheehan syndrome) and sudden bleeding into a tumour (apoplexy).
How it is diagnosed
- Pituitary hormone blood panel: Morning cortisol, thyroid hormones, prolactin, IGF-1, LH, FSH and sex hormones show which axes are over or underactive.
- Dynamic tests: Suppression and stimulation tests confirm Cushing's disease, acromegaly or cortisol and growth hormone deficiency.
- Pituitary MRI with contrast: Shows the size of a tumour and its relation to the optic nerves and cavernous sinuses.
- Visual field test: Formal mapping of side vision for any tumour near the optic chiasm.
- Inferior petrosal sinus sampling: A specialised catheter test used when the source of ACTH is unclear.
Treatment options
- Observation: Small non-functioning adenomas with normal hormones are followed with MRI.
- Dopamine agonist tablets: Cabergoline shrinks most prolactinomas and normalises prolactin, so surgery is rarely needed.
- Transsphenoidal surgery: Removal of the tumour through the nose with an endoscope; first choice for acromegaly, Cushing's disease and tumours affecting vision.
- Medical therapy for hormone excess: Somatostatin analogues, pegvisomant or cortisol-lowering drugs when surgery does not achieve control.
- Radiotherapy or radiosurgery: For residual or regrowing tumour. Its effect develops over years.
- Hormone replacement: Hydrocortisone, levothyroxine, sex hormones, growth hormone and desmopressin as needed, often lifelong.
When it is urgent
Sudden severe headache with vomiting, double vision, rapid loss of sight or drowsiness may signal pituitary apoplexy and needs emergency care at the nearest hospital. People with known cortisol deficiency who develop vomiting, severe illness or collapse need an emergency hydrocortisone injection and urgent admission.
Travelling to Türkiye for treatment
Travel is reasonable for a second opinion, a complete pituitary work-up over 3 to 5 days, or planned transsphenoidal surgery, for which you should allow 10 to 14 days and choose a team that operates on pituitaries regularly. Flying soon after surgery requires the surgeon's clearance because of the risk of spinal fluid leak. Hormone replacement, sodium checks in the first weeks and repeat MRI scans go on for years, so an endocrinologist at home must be part of the plan from the start.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
Is a pituitary tumour a brain cancer?
Almost never. Adenomas are benign and do not spread, although they can grow and cause problems through pressure or hormones.
Will I need surgery for a prolactinoma?
Usually not. Tablets control more than eight in ten, and the tumour often shrinks within weeks.
Can pituitary disease affect fertility?
Yes, through raised prolactin or low LH and FSH. It is often treatable, so tell your specialist if you plan a pregnancy.
What are sick day rules?
If you take hydrocortisone, you must double or triple the dose during fever or illness and carry an emergency injection. Your endocrinologist should teach you this.