Pituitary Tumor Specialist in Ahmedabad

What is a pituitary tumour?

The pituitary gland sits in a small bony pocket, the sella turcica, at the centre of the skull base, directly behind the nose and just below the optic nerves. It is the body's master gland, directing the thyroid, adrenal glands, ovaries and testes and producing growth hormone and prolactin. A pituitary tumour, almost always a benign adenoma, is an overgrowth of one type of pituitary cell. Adenomas are common, found in up to one in ten people on scans, and most never cause problems. Those that do are grouped in two ways:

Symptoms of a pituitary tumour

• Vision changes: loss of the outer (side) fields of vision, blurred vision or double vision
• Headaches, often behind the eyes or at the front of the head
• Hormonal symptoms in women: irregular or absent periods, milk discharge, infertility
• Hormonal symptoms in men: low libido, erectile dysfunction, loss of body hair
• Enlargement of the hands, feet and jaw, or change in facial features (acromegaly)
• Weight gain, rounded face, easy bruising, high blood pressure and diabetes (Cushing's disease)
• Fatigue, low blood pressure, cold intolerance and weight change from hormone deficiency
• Sudden severe headache with visual loss (pituitary apoplexy), which is an emergency

Many of these symptoms develop so gradually that they are attributed to age or stress for years. Our article on early signs of a pituitary tumour helps patients and families recognise them sooner.

Diagnosis

1. 01

   Hormone blood tests

   Prolactin, growth hormone and IGF-1, cortisol and ACTH, thyroid and sex hormones. These identify functioning tumours and any deficiencies that need replacement before surgery.

2. 02

   MRI of the pituitary

   A dedicated contrast MRI with thin slices through the sella shows the size of the tumour and its relationship to the optic chiasm, the cavernous sinuses and the carotid arteries.

3. 03

   Visual field testing

   Formal perimetry documents any loss of vision, which is one of the main indications for surgery and a key measure of its success.

4. 04

   Multidisciplinary review

   Dr. Patel, the neurosurgeon and the endocrinologist decide together whether the tumour needs surgery, medication (as for most prolactinomas) or observation.

Treatment options

Not every pituitary tumour needs an operation. Prolactinomas are usually treated with tablets (cabergoline) that shrink the tumour and normalise hormone levels. Small non-functioning adenomas that are not affecting vision or hormones can be monitored with periodic MRI. Surgery is recommended when a tumour is pressing on the optic nerves, producing excess growth hormone or ACTH, growing on serial scans, or has bled (apoplexy).

Endoscopic endonasal transsphenoidal surgery

This is the standard operation for pituitary tumours and the procedure Dr. Parin Patel performs, in a two-surgeon team with neurosurgery. Under general anaesthesia, an endoscope and fine instruments are passed through the nostrils to the sphenoid sinus, which lies directly in front of the pituitary. The thin bone of the sella is opened, and the tumour is removed piece by piece under high magnification, using image-guided navigation, while the normal gland is preserved. The opening is sealed with fat, fascia or a nasoseptal flap. There are no external incisions and no brain retraction. Full details of the technique are on our endoscopic skull base surgery page.

Extended and combined approaches

Large tumours that extend far above the sella or into the cavernous sinus may need an extended endonasal approach or, occasionally, a combined approach with a craniotomy. Dr. Patel's skull base training allows the safest route to be chosen for each tumour; see skull base surgery in Ahmedabad.

Radiotherapy and medication

Stereotactic radiosurgery or fractionated radiotherapy is used for tumour that cannot be safely removed or that regrows. Medication controls hormone excess when surgery has not normalised levels. Lifelong endocrine follow-up ensures that any hormone deficiency is treated.

Why Dr. Parin Patel

• Skull Base Surgery Fellowship at Tata Memorial Centre, Mumbai
• Head, Neck and Skull Base Surgical Oncologist with more than thirteen years of experience
• Two-surgeon endoscopic pituitary team with neurosurgery at HCG Aastha Cancer Centre, with navigation and endocrine support on site
• Preservation of normal gland function as a stated goal of every operation
• Coordinated pre- and post-operative endocrinology and ophthalmology

Read about his training and approach.

Recovery after pituitary surgery

Patients are usually mobile the next day and discharged within three to four days. Fluid balance and sodium are monitored closely for the first week, because temporary diabetes insipidus (excessive thirst and urination) can occur and is easily treated. Steroid cover may be needed until the normal gland recovers. Nasal congestion and crusting settle over a few weeks with saline rinses; nose-blowing and straining are avoided for a month. Hormone levels are rechecked at six weeks, and an MRI at three months shows the result. Most patients are back at work within two to three weeks. Our article how long does recovery take after endoscopic skull base surgery? gives a week-by-week outline.

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