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Forum Name: Endocrinology Topics

Question: 9mm Pituitary Tumor


 pecandelight - Tue Nov 08, 2005 8:36 pm

Would a tumor this size need to be surgically removed? I am currently not having any symptoms. Although I get headaches, I can not be sure they are from this tumor. I have another MRI scheduled for Dec. to compare the tumor's size from last time, but my endocrinologist said that this size is usually not removed.
My surgeon on the other hand is gung ho....
 whiskeygyrl - Fri Jan 27, 2006 9:42 pm

Most pit tumors cause cushing's, and yes this could be causing your headaches. Let me know if you would like more info on this disease.
 Dr. Shank - Fri Feb 03, 2006 9:59 pm

Dear pecandelight:

Very few pituitary tumors cause Cushing's.

The vast majority of pituitary tumors produce an excess of prolactin. Prolactin-secreting tumors should treated medically. Period. They should never be removed surgically, no matter what their size, because they shrink so dramatically with medical therapy.

A much smaller group of tumors produce an excess of somatotropin, which is better known in children as "growth hormone." The official "standard of care" for these tumors is surgery, regardless of the size, but every practicing endocrinologist that I know rejects these guidelines. Most of these tumors can be controlled in size and secretions with medications. (The effects of somatotropin can be blocked without affecting anything else, but this does not prevent the tumor from possibly slowly growing over time, so it is not very good as the only treatment of a tumor as large as yours.).

An even smaller group of tumors produce an excess of adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce too much cortisol. When caused by a pituitary tumor, this excess is commonly known as "Cushing's disease." It is difficult to treat these tumors medically, and they should generally be surgically removed, although medical treatment of the tumor and to block the excess production of cortisol from the adrenals can be tried.

An extremely rare group of tumors produce thyroid stimulating hormone (TSH) or leuteinizing hormone (LH) and follicle stimulating hormone (FSH). If you have one of these, you should go to a major pituitary center, because so little is known about them.

Another very small group of tumors produces a mere fragment of a pituitary hormone, known as alpha-subunit, and yet another very small group produces nothing that we can measure, at all. Most of these do not respond to medical therapy, but surgery is still not appropriate, unless they cause problems because of their size (unlikely at 9 mm).

Since a tumor that does not produce prolactin can interfere with the brain's ability to keep prolactin secretion by the rest of the pituitary low, prolactin levels may be high in tumors that do not secrete it. A few tumors produce both prolactin and somatotropin.

Headaches are common with pituitary tumors and have been found to correlate with the levels of prolactin in the fluid around the pituitary gland (although no one is sure why), but not the prolactin levels in the blood.

The fact that you are not having any symptoms makes Cushing's disease extremely unlikely. If you truely do not have any symptoms, then an excess of somatotropin is also unlikely. Some people with prolacin-secreting tumors do not have symptoms, but most men and pre-menopausal women do.

You say that your surgeon is "gung ho" to operate. There is no kind way of saying what I need to say about that, so I will be blunt: The only reason he is "gung ho" is because he gets so few opportunities to operate on pituitary tumors. If he were an expert pituitary surgeon, he would be working very closely with your endocrinologist and avoiding surgery. Keep your endocrinologist and dump that surgeon--if you ever do need pituitary surgery, you will want your endocrinologist to refer you to someone else to do it, anyway!

Endocrinologists are experts in glands and hormones.

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