• Aditya Gupta, Director of Neurosurgery and Cyberknife at Artemis Hospital Gurugram

What is a pituitary gland tumor?

Pituitary gland, which is also known as the master gland has the most important function of producing hormones that regulates the critical organs of the body including thyroid, adrenal glands, ovaries and testes. It is a small pea-size gland located behind the eyes and below the front of the brain. Improper functioning of the gland usually results in excess or under production of hormones that leads to a formation of mass called tumor, which can be benign or malignant. Such tumors in this gland can create numerous serious medical conditions by interfering with the normal functioning of the endocrine system and pituitary gland. Some tumors produce hormones known as functional tumors, and others can cause the glands to secrete too few or too many hormones. Also if the tumor pressed on the nearby structure, for instance the optic nerve, can also limit a person’s vision.

Though the occurrence of tumor is more likely after the age of 50 years, it still can impact at an early age. The survival rates of tumor due to its complicated location also depend on other factors like the patient’s age, type and size of tumor.

What causes a pituitary gland tumor?

Mostly, pituitary gland tumors are non cancerous but the exact causes are unknown. Some of them are hereditary and some are caused by a rare genetic disorder called as multiple endocrine neoplasia type 1. This disorder can also lead to over-activity or enlargement of 3 different endocrine-related glands, which also includes the pituitary gland. Many researches are still underway to know the exact cause of such uncontrolled growth of certain cells that leads to a pituitary tumor.

What are the symptoms?

Depending upon the hormonal variations in the body, there can be a variety of symptoms. The most common symptoms include Headaches, vision problem, tiredness, mood changes, irritability, changes in menstrual cycle in women, impotence, infertility, Inappropriate breast growth or production of breast milk, Cushing’s syndrome which is a combination of weight gain, high blood pressure, diabetes, and easy bruising, the enlargement of the extremities or limbs, thickening of the skull and jaw caused by too much growth hormone.

Treatment for Pituitary gland tumor

Diagnosis at an early stage can help the treatment procedure to be totally non-invasive with the use of advances technology called as Cyberknife. Cyberknife which is the most advanced radiation therapy is completely non-invasive therapy available for the treatment of benign as well as malignant tumors. Highlights of the therapy being ease of access to any complex location without the need to use the surgical knife, precision of the beam with high dose radiation to the tumor location, and the safety. It is a day care procedure without pain and risk, and the patient can get back to daily chores as soon as the session gets over which depends on the tumor (30 minutes to 1 hour) and hence eliminates the requirement of any hospital stay. Moreover the procedure makes use of the most sophisticated image guidance technique to focus high doses of radiation directly to the tumor spot which eliminates the chances to damage the healthy cells as in any other methods of treatment.

This therapy works the best for tumors that are upto 1-3

cm in size (for pituitary tumors, this figure is even smaller) and is a very powerful and effective technique for treating patients suffering from early stage primary and medically inoperable tumors.

The treatment is safe to administer and also offers a new option in patients with recurrent pituitary tumors, those that cannot be operated, or those involving the cavernous sinus (an area difficult to reach and completely remove tumors from, without side effects).

Phasing of the cyberknife procedure

1. Planning –To have enough time with the surgeon to design and finalize a customized treatment plan, imaging is performed a few days in advance.
2. Treatment –Once the plan is set in place, the patient will return for a non-invasive, pain-free treatment experience. Using advanced tumor-tracking technology, the CyberKnife system is able to deliver either one single high-dose treatment, or smaller doses (upto 5) over the course of two to five days, depending on the plan generated. This approach limits side effects and enables most patients to return to their regular routine the same day.

Each session of treatment usually lasts for about 30 -50 min and is cost effective with a success rate of 98% in such complicated tumors. Patients with pituitary adenomas receive stereotactic radio surgery with CyberKnife and are followed up for more than 12 months. After 6 months of therapy patients are monitored for positive responses and ensure there is no recurrence of any mass.

Typically MRI is doing 6 monthly for the first year, and then yearly for at least 5 years.

Pituitary tumors that are larger,  and create pressure on the optic nerves are better dealt by endoscopic removal of the tumor through the nose.