Pituitary is the master Endocrine gland, like other Endocrine gland it can be affected by tumour. Fortunately most pituitary tumour are benign. The symptom of pituitary tumour are headache, sight problem or problems with Pituitary hormone secretion as told before. Once diagnosed we need to find out the extent of the tumour and most importantly the functional state of the Pituitary hormones.Prolactin secreting tumours can be managed by medical therapy.
When is surgery needed?
Pituitary surgery is required when there is a tumor in the pituitary gland a. Secreting excess hormones b. Causing compression of adjacent structures like the optic nerve causing visual disturbance.
Where from they can touch the pituitary gland?
There are two approaches that are commonly used:
a. Transnasal approach : The pituitary gland is approached through the nose through the air sinus situated just in front of it. This is most commonly used.
b. Transcranial approach: The pituitary gland is approached through an opening made in the skull.
What are the possible complications of surgery of pituitary tumour?
The complications that can arise after surgery of pituitary tumour include:
a. There can be a leak of the brain fluid (Cerebrospinal Fluid - CSF) through the nose after surgery. It is usually transient and settles down soon after surgery.
b. Diabetes insipidus: The posterior pituitary is responsible for maintenance of water & electrolyte balance in the body. Pituitary operation sometimes causes alteration in the secretion of posterior pituitary hormone.
c. Hypofunction of Pituitary hormones: If not from before, Hypopituitarism can develop after Pituitary surgery. There is nothing to worry about that we can now very effectively replace the deficient Pituitary hormones.
When is radiotherapy used?
· Reduce the size of pituitary tumors
· Prevent further growth of pituitary tumours
· Post-operatively to markedly decrease the chance of symptomatic tumour recurrence
· Reduce excessive hormone secretion (such as growth hormone or ACTH).
What are the side effects of radiotherapy?
· Short term * Hair Loss : Some hair loss occurs at both sideburn areas (temples) temporarily which can be covered by scalp hair * Tiredness : Tiredness during and after treatment is quite normal. A good balance between activity and rest may actually help the feeling of tiredness · Long term * Hypopituitarism .:. Due to irradiation of hypothalamus leading to decreased releasing hormones * Visual impairment
Other forms of radiotherapy Local forms of radiotherapy - advantages are that a focused beam on the tumor with minimal damage to adjacent tissue
· Gamma knife radiotherapy
· The Gamma Knife offers a non-invasive alternative for many patients.
· Linear accelerator focal radiotherapy
· Radiosurgery can be preformed with linear accelerator machines.
· With radiosurgery, the radiation dose given in one session is usually less than the total dose that would be given in radiation therapy.