Pituitary Gland Tumor: Types of Treatment

Approved by the Cancer.Net Editorial Board, 04/2021

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with a pituitary gland tumor. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for pituitary gland tumor. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all types of tumors. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How a pituitary gland tumor is treated

For a pituitary gland tumor, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Health care teams may include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Any person with a pituitary tumor should be seen by an endocrinologist, which is a doctor who specializes in problems with glands, hormones, and the endocrine system. In addition, patients should be examined by a neurosurgeon, a specialist who operates on the head, brain, and central nervous system. Patients with vision problems will also need to visit an ophthalmologist, a doctor who specializes in the treatment and diagnosis of eye problems.

The common types of treatments used for a pituitary gland tumor are described below. Your care plan may also include treatment for symptoms and side effects, an important part of medical care.

Treatment options and recommendations depend on several factors, including:

  • The type and classification of the tumor

  • Possible side effects

  • The patient's preferences and overall health

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called "shared decision-making." Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for pituitary gland tumors because there are different treatment options.

Learn more about making treatment decisions.

Active surveillance

Active surveillance is an option for some people with a pituitary gland tumor who have no symptoms from the tumor and whose hormones are working normally. This approach can also be called watchful waiting. During active surveillance, the patient is monitored closely with periodic examinations and tests to watch for signs of tumor growth or progression. This may include regular MRI scans of the brain and the pituitary gland. Active treatment would begin only if the tumor started causing symptoms.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is the most common treatment for a pituitary gland tumor. Surgery is performed by a neurosurgeon. Surgery is often successful in removing the entire tumor.

About 95% of surgeries to remove a pituitary gland tumor are done by the transsphenoidal route. That means going through the nasal passage and along the septum that separates the 2 nostrils. Then the neurosurgeon follows the sphenoid sinus cavity located deep above the back of the throat to the pituitary gland immediately behind it. Another surgical approach is making a temporary opening in the skull called a craniotomy to reach the area. This can be done using a microscope or an endoscope, which is a long flexible tube, or both, so the neurosurgeon can see the tumor.

Both of these methods are equally safe and effective when done by a skilled surgeon. Before surgery, talk with your health care team about possible side effects from the specific surgery you will have, how they can be managed, and what to expect during your recovery.

Learn more about the basics of surgery for a tumor.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, or schedule, which is your treatment plan, usually consists of a specific number of treatments given over a set period.

For a pituitary gland tumor, radiation therapy can be delivered with either photons, protons, or gamma rays. Each of these treatments can be effective. The specific type that is used depends on the specific situation.

If the entire tumor is removed using surgery, then radiation therapy is not needed. For some patients, stereotactic radiation therapy is used when any part of the pituitary gland tumor is left after surgery. This kind of radiation therapy delivers a high dose of radiation directly to the tumor.

Not all patients with part of a tumor remaining after surgery need radiation therapy. That is because some benign pituitary gland tumors do not grow back even when some of the tumor is left behind after surgery.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most of these side effects go away soon after treatment is finished.

In the long term, radiation therapy may cause short-term memory or cognitive changes, meaning the thought process is affected. It can also cause the pituitary gland to gradually lose the ability to make hormones for the body after treatment ends. If this occurs, hormone replacement therapy (see below) may be needed. Talk with your doctor about what to expect based on your specific radiation treatment and how side effects will be managed.

Learn more about the basics of radiation therapy.

Therapies using medication

For pituitary gland tumors, treatments using medication are based on the body's hormones affected by the tumor and its treatment. Medication may be given through the bloodstream. When a drug is given this way, it is called systemic therapy.

This type of medication is generally prescribed by an endocrinologist or a medical oncologist, a doctor who specializes in treating tumors with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle it.

The types of medications used for pituitary gland tumor include:

  • Hormone replacement therapy

  • Drug therapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat people with a pituitary tumor are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

Hormone replacement therapy (HRT)

HRT is often necessary for people with a pituitary tumor when the gland is not making enough of a hormone due to the disease. This means the patient is given a replacement, often as a pill, to take regularly. This may include replacement of:

  • Thyroid hormones

  • Adrenal hormones

  • Growth hormone

  • Testosterone

  • Estrogen

Drug therapy

If a pituitary tumor is overproducing a hormone, there are medications that can help. The drugs bromocriptine (Parlodel) and cabergoline (Dostinex) are used to treat tumors that secrete prolactin. Octreotide (Sandostatin) or pegvisomant (Somavert) can be used to treat tumors that make growth hormone. Octreotide can also be used to treat pituitary tumors that secrete thyroid-stimulating hormone.

Physical, emotional, and social effects of a tumor

A pituitary gland tumor and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the tumor.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and classification of tumor, may receive this type of care. And it often works best when it is started right after the diagnosis. People who receive palliative care along with treatment for the tumor often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the tumor, such as medications, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan being recommended. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Aggressive pituitary gland tumor

If a pituitary gland tumor spreads to another part in the body from where it started, doctors call it a metastatic cancerous tumor. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

If a tumor grows quickly in the pituitary gland and spreads into nearby structures, it is called a locally invasive tumor. Both metastatic and locally invasive tumors can be aggressive, growing and spreading quickly. They are more likely to need treatment with radiation therapy than a noncancerous pituitary adenoma. However, many pituitary tumors do not grow quickly even when they are invasive, which is different from most other types of tumors.

Your treatment plan may include a combination of surgery and radiation therapy. Palliative care will also be important to help relieve symptoms and side effects.

For many people, a diagnosis of an aggressive pituitary gland tumor is very stressful and difficult. You and your family are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

Remission and the chance of recurrence

A remission is when the tumor cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the tumor will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the tumor returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.

If the tumor returns after the original treatment, it is called a recurrent tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence), which is rare. If there is a recurrence, the tumor may need to be evaluated again (called re-staging) using the system described in the Staging section.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery and radiation therapy. But they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent tumor.

Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with a recurrent tumor sometimes experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with a recurrence.

If treatment does not work

Recovery from a pituitary gland tumor is not always possible. If the tumor cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, an advanced tumor is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have an advanced tumor and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with a pituitary gland tumor. Use the menu to choose a different section to read in this guide.