Following a diagnosis of a pituitary adenoma, you may be faced with a number of decisions. To ensure you feel as comfortable as possible with your condition and your doctor’s recommendations, you should develop a better understanding of your pituitary adenoma treatment options. This way, when you sit down with your medical team to plan your next steps, you will have a more informed opinion and be able to play a more active role in your treatment planning.
What Factors into Treatment Options
The first thing your doctor will take into consideration is whether or not your pituitary adenoma is functioning or nonfunctioning. The pituitary gland is made up of many different types of cells, each of which secrete a special hormone into the bloodstream. If your tumor is made up of secretory cells, it may be releasing abnormally high amounts of a particular hormone and causing the symptoms you are experiencing. This is a functioning tumor. If it does not secrete anything, it is considered non-functioning.
All functioning tumors must be treated in order to stop the symptoms because of the release of extra hormones from the tumor cells. Some functioning pituitary adenoma types can be treated with medication while some types of functioning pituitary adenomas require surgical resection.
For non-functioning tumors, if it is not causing any symptoms and not putting any pressure on the optic nerves, your doctor may suggest a “watch-and-wait” approach, choosing to monitor its size for any changes over time. He or she may also suggest forgoing non-functioning pituitary adenoma treatment if your tumor is particularly small.
Your doctor will also take into consideration your individual health history. This includes your age, weight, the characteristics of your tumor and whether or not you have any complicating health conditions that would impact your pituitary adenoma treatment options.
Treatment Options
There are three overall approaches to pituitary adenoma treatment: surgery, Gamma Knife Radiosurgery and a combination approach. Your doctor will make the recommendation that he or she feels will be most effective for you based on the factors discussed above.
Surgery
The first surgical approach is also the most common, in which the surgeon uses a microscope or endoscope to access your pituitary adenoma through the back of your nose. This is called a transnasal or transsphenoidal procedure. Using this technique, the surgeon uses microscopic visualization and specialized instruments, avoiding an incision in the skin and allowing for a minimally invasive procedure.
Following the administration of general anesthesia, the surgeon places a retractor in the nose and will either use an operating microscope or an endoscope with a camera to access and visualize your tumor. He or she will remove the tumor using very precise instruments, disturbing as little of the surrounding soft tissue as possible. Very rarely, a craniotomy must be performed if the surgeon cannot remove all of the tumor using the transnasal, transsphenoidal approach.
During a craniotomy, the surgeon removes a small section of the skull for better access to your tumor. After the procedure, the section of skull is replaced and may be held in place with small screws or a plate. If your tumor is very large or difficult to reach or if your surgeon was not able to remove it completely using the transnasal, transsphenoidal endoscopic or microscopic approach, a craniotomy may be necessary.
Gamma Knife Radiosurgery
Gamma Knife Radiosurgery, or stereotactic radiosurgery, isn’t actually surgery at all. Rather, it is a form of radiation therapy that delivers a highly focused beam of radiation directly to your tumor, sparing surrounding healthy tissue.
Gamma Knife Radiosurgery is typically used in the treatment of pituitary adenoma if your tumor is relatively small or if you are not a good candidate for surgery because of your individual health history. It is often used in combination with surgery, as described below.
A Combination Approach
Gamma Knife Radiosurgery is typically used as a secondary treatment following surgical removal of a pituitary adenoma. If the doctor cannot remove all of your tumor using surgery, he or she may recommend Gamma Knife Radiosurgery to eliminate any remaining tissue, particularly if it is a small section of tumor. Additionally, Gamma Knife Radiosurgery may be used if your tumor was surgically removed but begins to regrow.
The Right Treatment for Your Case
Pituitary adenomas can vary widely in size, cell type and whether or not they are functioning or nonfunctioning. You are an individual with a personal health history and tumor that is not exactly like the next person’s, and it is important you receive care tailored to your specific case. Take the time to find an expert in the treatment of pituitary adenomas, someone you can be comfortable with and who will work with you to determine which treatment option is right for you.
It’s great that you have chosen to educate yourself about your condition and treatment options. Carry this information forward as you move through the treatment planning process and have a frank discussion with your doctor about your questions and concerns. He or she will ensure you feel comfortable before, during and after your treatment as you make your way to recovery.
