Most pituitary tumours are benign (non-cancerous) growths called pituitary adenomas, and many can be treated very effectively. Some need surgery, some are best treated with tablets, and some small ones only need regular monitoring. For patients in Lahore, the first step is a careful assessment of the tumour on MRI and of your hormone levels, because the right treatment depends on what type of adenoma it is and whether it is pressing on the nerves of sight.
The pituitary is a pea-sized gland at the base of the brain, sitting just below the optic nerves. Because of this position, a pituitary tumour can cause problems in two ways: by producing too much of a hormone, or by growing large enough to press on vision and the normal gland.
A pituitary adenoma is a slow-growing lump arising from the cells of the pituitary gland. Doctors divide them into two main groups:
Tumours under 1 cm are called microadenomas; larger ones are macroadenomas. Other lesions in the same area, such as craniopharyngioma or Rathke's cleft cyst, can look similar and are discussed on our skull base tumour surgery page.
Occasionally a pituitary tumour suddenly bleeds or loses its blood supply. This is called pituitary apoplexy. Typical signs are a sudden severe headache, vomiting, sudden loss of vision, double vision or a drooping eyelid, and drowsiness or collapse. This is a medical emergency. Go to the nearest emergency department straight away, as urgent steroid treatment and sometimes urgent surgery may be needed.
In most people there is no clear cause and nothing the patient did to bring it on. A small number of pituitary tumours run in families as part of inherited syndromes such as MEN1. Pituitary adenomas are common and are not contagious or caused by stress or diet.
A small non-functioning adenoma that is not affecting vision or hormones can often be watched with repeat MRI scans and blood tests. Many never grow enough to need treatment.
Prolactinomas are different from other pituitary tumours. They usually respond very well to tablets (dopamine agonists such as cabergoline), which lower prolactin and often shrink the tumour, even large ones pressing on vision. Surgery is usually reserved for patients who cannot tolerate the medicine, whose tumour does not respond, or in some other specific situations.
Surgery is usually the main treatment for non-functioning adenomas affecting vision, for acromegaly and for Cushing's disease. Most pituitary tumours today are removed through the nose using endoscopic pituitary surgery (endoscopic endonasal transsphenoidal surgery), with no cut on the face or scalp. This is one of the most common forms of endoscopic brain surgery. A small number of very large or unusually shaped tumours need an open operation (craniotomy) or a combined approach.
If some tumour remains, particularly where it has grown into the cavernous sinus next to the carotid artery, it may be watched, treated with targeted radiotherapy or radiosurgery, or, for hormone-producing tumours, controlled with medicines.
After endoscopic surgery, many patients stay in hospital for a few days so that fluid balance and hormone levels can be monitored. Vision often starts to improve within days to weeks if the nerves were compressed, although long-standing visual loss may not fully recover. Most people return to light activity within a couple of weeks and to desk work within a few weeks, depending on how they feel. Hormone tests and a follow-up MRI are arranged over the following months, and some patients need long-term hormone replacement.
Pituitary surgery is generally well tolerated, but risks include a leak of brain fluid (CSF leak) through the nose, temporary or occasionally permanent diabetes insipidus (passing large amounts of urine), new hormone deficiencies, nasal crusting and congestion, bleeding, infection such as meningitis, and rarely worsening of vision or injury to the carotid artery. These are discussed in detail before any operation. More information on how the operation is done is on the endoscopic pituitary surgery page, and other tumour types are covered on our brain tumour surgery page.
Almost all pituitary adenomas are benign. They do not spread around the body, although they can still cause serious problems through hormone excess or pressure on vision. Pituitary cancer is very rare.
No. Small tumours that are not causing symptoms can often be monitored, and most prolactinomas are treated with tablets. Surgery is usually advised when vision is affected, for acromegaly and Cushing's disease, or when a tumour is growing.
Many patients notice improvement in their vision after the pressure is relieved, sometimes within days. How much recovers depends on how severe and how long-standing the loss was, so it is important not to delay assessment if your side vision is reducing.
Some patients do, especially if the tumour was large or the gland was already underactive before surgery. Others recover normal function. Your endocrinologist will check your hormone levels after surgery and advise you.
Bring your MRI, hormone reports and any eye test results to your consultation. You can book an appointment online or by phone.
Dr. Khawar Anwar is a Consultant Neurosurgeon & Spine Surgeon at PINS / Lahore General Hospital, Lahore, with over 10 years of experience in brain and spine surgery. He sees patients in Lahore and Gujranwala and focuses on minimally invasive and endoscopic techniques where they are suitable for the patient.
See the full list on the certifications page or read more about Dr. Khawar Anwar.
See all clinics, maps and timings on the locations page.
To book, call or WhatsApp 0333-7574732 and tell us which clinic and day suits you. Please bring your MRI or CT scan (films and CD), reports and a list of your current medicines to the consultation. For sudden weakness, loss of bladder or bowel control, a sudden severe headache or a head or spine injury, go to the nearest emergency department first.