Pituitary tumors (adenomas) that do not secrete active hormones are called clinically nonfunctioning pituitary adenomas. Most are large (macroadenomas), measuring more than one centimeter in size at the time of diagnosis. Patients start experiencing symptoms when the large tumor compresses the optic nerves, leading to vision loss, or the loss of normal pituitary function.
The UCLA Pituitary Tumor Program offers comprehensive management of clinically nonfunctioning pituitary adenomas. Our physicians have years of experience in diagnosing, treating and managing pituitary conditions.
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Clinically nonfunctioning pituitary adenomas make up about half of pituitary adenomas. The vast majority of them are benign.
There are several possible reasons why nonfunctioning pituitary adenomas could occur:
The most common symptoms are due to the large tumor compressing nearby structures, leading to:
Increased compression of the normal gland can cause hormone insufficiency, called hypopituitarism. The symptoms depend upon which hormone is involved.
More severe hypopituitarism can lead to hypothyroidism or abnormally low cortisol levels, which may be life threatening. Symptoms of severe hypopituitarism include:
Changes in hormonal function can cause electrolyte imbalance in the blood, typically low sodium levels (hyponatremia). Symptoms could include:
Imaging scans are one method doctors use to diagnose clinically nonfunctioning pituitary adenomas. We will also order hormone tests to evaluate the levels of pituitary hormone, confirming that there is no evidence of hormone production by the tumor.
Your doctor will conduct a thorough physical examination and ask you about your symptoms and medical history. He or she will then order tests as necessary, including:
MRI imaging allows us to detect whether there are tumors present. Your doctor will use a special MRI pituitary protocol to best visualize the tumor.
There are other tumors that produce symptoms similar to that of a pituitary adenoma. Your doctor will want to rule out these other tumors before confirming a diagnosis. Tumors that mimic the symptoms of a pituitary adenoma include:
If your symptoms suggest pituitary failure (hypopituitarism), your doctor may order a complete evaluation of the endocrine system. Based on results of these blood tests, you may undergo additional hormonal studies.
Learn more about hormone testing at the UCLA Pituitary Tumor Program.
If you are experiencing vision problems, your doctor will recommend that an experienced ophthalmologist evaluate you. The evaluation should include:
This will determine if you have a loss of peripheral vision.
The UCLA Pituitary Tumor Program offers comprehensive management of all types of pituitary tumors. Treatment options for pituitary adenomas include:
For most patients with nonfunctional adenomas, surgically removing the adenoma is the most effective treatment.
Whether this will lead to a long-term cure depends on the extent of surgical removal, which is related to:
If the surgeon was able to remove the entire tumor, the cure rate is 70 percent to 80 percent. Overall, surgery improves:
If the pituitary adenomas require surgery, typically the best procedure is through a nasal approach. Our neurosurgeons who specialize in pituitary tumor surgery are experts in the minimally invasive endoscopic endonasal technique. This procedure removes the tumor while minimizing complications, hospital time and discomfort. This advanced technique requires specialized training and equipment.
Very large tumors that extend into the brain cavity may require opening the skull (craniotomy) to access the tumor. Our surgeons are also experts in the minimally invasive "key-hole" craniotomy, utilizing a small incision hidden in the eyebrow.
If, after your surgery, some tumor cells remained or regrew, you may be a candidate for radiation therapy or a repeat surgery.
Hormone replacement may be necessary if you have pituitary insufficiency.
Doctors may recommend radiation therapy as a second-line therapy for endocrine-inactive tumors. Focused-beam radiation, named stereotactic radiosurgery, can be effective in controlling tumor growth. In some cases, radiation therapy may cause a loss of pituitary function.
To schedule an appointment with one of our physicians at the Pituitary Tumor Program, please call (310) 825 5111.
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