Pituitary Adenoma Radiation Therapy

The most common brain 🧠 tumor is a pituitary tumor. About 25% of people may have small pituitary tumors without knowing it. These are often found incidentally on brain imaging done for unrelated reasons. The pituitary is a small gland in the brain, located behind and in between the eyes. It makes hormones that affect many other glands and functions in the body.

Fortunately, most pituitary tumors are benign and rarely require treatment. But occasionally they can cause the pituitary to make too few or too many hormones, causing problems in the body. Pituitary tumors that make too many hormones include:
—Prolactin-producing tumors (prolactinomas). If you are a woman, high prolactin levels can make your menstrual period irregular, or even stop your period. These tumors can also cause you to make breastmilk, even if you are not pregnant or nursing. If you are a man, you may have erectile dysfunction or a lack of interest in sex. You may also have enlarged breasts, a low sperm count, or less body hair. In time, you may have headaches and vision problems.
—ACTH-producing tumors:
ACTH (adrenocorticotropic hormone) stimulates the adrenal gland to make steroids that affect metabolism. These are called glucocorticoids. They reduce redness and swelling all over the body. They also slow down your immune system. Too much ACTH can cause Cushing's disease. This disease causes fat buildup in your face, neck, back, belly and chest. Also your arms and legs tend to become thin. You may also have purple stretch marks and high blood pressure. These tumors can also weaken your bones.
—Growth hormone-producing tumors:
These tumors make too much growth hormone. In children, too much growth hormone stimulates the growth of almost all the bones in the body. When that occurs, the result is called gigantism. Gigantism can include increased height (over 7 feet), very quick growth, joint pain, and heavy sweating. In adults, too much growth hormone causes a condition called acromegaly. It may include:
-Extra growth in the skull, hands, and feet
-Deepened voice
-A change in the facial appearance because of extra growth in the facial bones
-A wide spacing of teeth because of the growth of facial bones
-Joint pain
-Snoring or sleep apnea
-Diabetes or impaired glucose tolerance
**famous individuals with this condition include: Richard Kiel (actor, "Jaws" from two James Bond movies), Tony Robbins (motivational speaker) and André the Giant.

Occasionally, pituitary tumors can grow large enough that they will press against the nearby optic nerves. This can cause vision problems.

Treatment for these symptomatic tumors can include hormonal drug therapy, surgery (often performed through the nose using sophisticated guidance technology) and/or radiation treatment.

In this patient, radiation (volumetric arc intensity modulated radiation therapy, VMAT-IMRT) is being used after a second recurrence following two prior surgeries to remove tumor. This patient had a very large tumor that was compressing the optic chiasm and was invading into the cavernous sinuses, areas challenging to resect. The success of radiation therapy at preventing further growth of this non-functioning (non-hormonal) tumor is greater than 90%, and has a very low risk (less than 1%) of causing injury to the optic nerves. Due to the large size of the area needed to be treated, we are using a 5.5-week course of daily radiation treatment (5-minutes/day, 5-days/week). Smaller tumors can be treated with only 1-5 treatments called “stereotactic radiosurgery” or SRS (see my last video post about this technique).

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  Pituitary Gland Tumor