Headaches are the most common initial symptom
and the majority of patients experience headaches sometime during the course of
Typical brain tumor headaches come and go and do not throb. They
are worse in the morning and improve gradually during the day. They may rouse the
person from sleep. These headaches may worsen with coughing or exercise, or with a
change in body position - such as bending or kneeling.
Headaches are due to pressure in the brain. Some people experience neck pain as well.
Seizures are another common symptom of brain tumors. About half of all patients
experience some form of seizure during the course of their illness.
Seizures are caused by a disruption in the normal flow of electricity in the brain.
Those sudden bursts of electricity can cause a variety of symptoms including convulsions,
unusual sensations, and loss of consciousness.
Mental changes frequently occur. These changes include problems with memory,
speech and communication, reasoning, or concentration. Changes in behavior,
temperament, interests or a state of confusion are other indications of mental change.
Mental changes may be caused directly by the tumor or by the increased
pressure within the skull (intracranial pressure) it creates.
Nausea and vomiting; drowsiness; vision problems, such as blurred
or double vision, or loss of some visual fields; as well as the headaches
and mental changes already mentioned, are symptoms often caused by
increased intracranial pressure (IICP).
This IICP is due to
1) the tumor's growth within the skull - an area
enclosed by bone which cannot expand, and/or
2) blockage of the fluid that flows around and through the brain
3) swelling of the brain around the tumor due to an accumulation of fluid.
These all cause what is called mass effect. Mass effect may cause further
damage by compressing and displacing delicate brain tissue.
In addition to the common, but non-specific symptoms listed above,
other more specific symptoms frequently occur. They help identify the
These symptoms include: hearing problems such as
ringing or buzzing sounds or hearing loss, decreased muscle control
and lack of coordination, decreased sensation, weakness or paralysis,
difficulty with walking or speech, balance problems and crossed eyes.
The pituitary is called the "master
gland". It secretes several important hormones.
Headache, vision changes, and diabetes insipidus (a type of hormone disturbance)
are common symptoms of this. Because these tumors often secrete hormones inappropriately,
other symptoms vary depending on the type of hormone secreted.
This Information found at
The pituitary gland is a small oval
structure located at the base of the brain in the center of the head,
behind the eyes and optic nerve. It is about the size of a pea but is
very important because it secretes several chemical messengers known as
hormones, which help control the body's other glands and regulate growth,
metabolism, maturation and other essential body processes.
A tiny tumor located just next to the gland, pituitary adenomas
account for about 10% of brain tumors. Doctors classify pituitary
tumors into two groups secreting and non-secreting.
Secreting tumors release unusually high levels of pituitary hormones,
triggering a constellation of symptoms. They are usually much smaller than
the gland when they begin to cause symptoms and the symptoms depend on
the tumor's size and the kind of hormone the tumor secretes.
Prolactinsecreting adenomas affect sexual characteristics and cause
impotence in men. Adenomas secreting growth hormone cause acromegaly
abnormal body growth, enlarged facial features, hands and feet) and
gigantism (excessive size and stature). The less common adrenocorticotropic
hormonesecreting adenoma causes Cushing's disease.
Some adenomas secrete a combination of these or other hormones and some
secrete none. Almost all adenomas are benign, but their slow expansion
compresses normal structures that surround it, suppressing normal pituitary
function and sometimes causing headaches or problems with vision.
Pituitary adenomas rarely metastasize or spread to other areas of the body. They are
removed in an operation using microsurgical techniques, a very successful
form of treatment for the majority of patients.
This information found at
by John R. Mangiardi, M.D. and Howard
The pituitary gland is a half-breed in many ways. It is not really a part
of the brain, but rather hangs beneath it. Half of the gland comes down from
the brain (the posterior lobe which controls the body's water levels and
secretes the hormone ADH - anti-diuretic hormone).
The other half comes
from tissues originating from the roof of the embryonic mouth, the anterior
lobe which controls sex hormone levels, lactation, growth hormone, body
steroids, and the thyroid gland).
The pituitary is responsible for almost all of the body's hormonal
systems, taking all of its cues from the hypothalamus, the hidden and very
deeply located Grand Wizard of the brain. The hypothalmus also controls
such activities as body temperature, sexual drive, appetite, blood glucose
levels, and sleep/arousal behavior patterns.
As elsewhere in the brain, tumors of the pituitary gland behave according
to their cell of origin. Most of these tumor are truly benign, although on
occasion they may prove to be malignant (pituitary carcinomas).
The list of
cells of the pituitary determines the tumor types, as well as the clinical
syndromes related to each. Almost all have the good prognosis which calls
for total removal. On the other hand, almost all can eventually become
"malignant by position".
This is especially true when the tumors grow off to either side,
involving the jam packed structures behind both eyeballs, called the
"cavernous sinuses". The pituitary gland is located exactly between
these two structures, which contain the nerves that control eye movement
and the major arteries that feed the brain (carotid arteries, the veins
that drain the eyes and other nerve related structures).
these tumors may occasionally present the patient with double vision,
or even something called "Pituitary Apoplexy" (severe sudden headache,
loss of and/or double vision, protruding eyeball).
Each tumor, because of its extraordinarily high hormonal output,
creates a characteristic clinical syndrome that brings attention to
the tumor. Because the pituitary gland is located directly beneath
the place where the nerves cross, coming from the eyes to the brain
(the optic chiasm), many tumors also present - along with the hormonal
problems listed below - loss of peripheral vision.
Gigantism: This syndrome is
caused by pituitary tumors on the growth hormone secreting cells of the
pituitary gland. Remember Lurch from the James Bond movie - large
hands, protruding jaw, severe arthritis, huge size, protruding eyebrows,
plus other systemic problems - a classic example of gigantism.
Cushings Disease: This syndrome is caused by tumors on the ACTH
(Adrenal Corticotrophin Hormone) secreting cells of the pituitary gland.
Patients with this problem develop fat deposits in strange places
(Moon face, Buffalo hump on the back of the neck), spontaneous scarring
of the skin along the belly that look striated, pimples in adults, high
blood pressure and elevated body temperature.
These tumors are usually so
small that the surgeon might have a difficult time finding the little
"bad pearl" in the gland during surgery. This is the one time when small
can be bad, especially if the surgeon is unable to locate and remove the
tumor! ACTH secreting tumors, although small and troublesome, are readily
cured by surgery alone.
Prolactin Syndrome: This syndrome is caused by tumors on the
prolactin secreting cells of the pituitary gland. The tumors are the
most common of all the pituitary tumors. Production of breast milk in
women who are not pregnant, loss of menstrual cycle, and loss of bone
calcium are all hallmarks of this tumor.
When small, it may be cured;
when large, it may cause visual problems and require other (e.g. radiation)
therapy. Many women with this tumor visit their gynecologist thinking that
they might be pregnant.
Growth hormone secreting tumors may very occasionally be treated with
drugs, but most often must be removed surgically.
Non-Secreting Tumors: Can be treated by surgery and/or radiation.
These patients almost always have problems with vision, as the hormonally
quiet tumor grows to over-sized proportions, actually growing to the point
of lifting up and stretching the optic nerves (especially where the nerves
from both eyes cross as they travel to the brain).
The treatment of these
tumors is variable. Prolactinomas are most often treated non-surgically
with drugs that inhibit prolactin production (parlodil). Microprolactinomas
sometimes never really grow over long periods of time, and do not require surgery.
All pituitary tumors can be treated by radiation, especially with the
improvements brought on by focused beam radiation (liner accelerator and
proton beam). The idea of radiosurgery originated in this venue.
problem with radiation has been loss of function in the remainder of the
pituitary gland, requiring patients to depend on hormone supplements for
the continuation of their lives. Another has been the inability to quickly
reverse visual loss in large tumors using radiation. On the other hand,
radiation has been used as a very successful adjunct in larger tumors that
pose a threat to long term survival.
Surgery on Pituitary Tumors
pituitary gland lies just above the air spaces in the nose (if you'd stick a
pencil through your nose hard enough, you'd end up in your pituitary gland).
In fact, the word "pituita" refers to the not so
delicate production of "snot". In medieval times in Europe, and in China today,
it is thought that "pituita" was something good to get rid of, serving as a
relief valve for bad humors of the brain. In other words, spitting was good
for the soul as well as one's health.
Thus, by traversing the structures just beneath the skull through the nasal
cavities, brain surgery can be avoided and the risk of approaching the
pituitary gland can be enormously reduced.
Decision Making for
Pituitary Tumor Surgery
It's an Emergency: Patients who have
a large pituitary tumor (and often don't even know about it) will occasionally
develop a kind of pituitary "stroke", called pituitary apoplexy.
after the tumor outgrows its blood supply and suddenly enlarges (due to swelling)
after it infarcts (a type of local stroke), or begins bleeding within the tumor.
The enlargement causes severe headache and/or double vision, because the nerves
that control the eye located next to the gland are pressed upon.
It can also cause
loss of vision (because the gland swells upward, pressing from beneath the optic
nerves above). Surgical decompression is an emergency procedure because permanent
blindness may result if left untreated.
Surgery Is the Best Way to Go
Cushing's Disease: Because the tumor is so
small, a cure is possible when removed. Thus, surgery is the best way to go. Moreover,
the remainder of the gland is left intact, and will function normally thereafter.
Large tumors with liquified (necrotic) centers: In these cases, the
surgery is easy, and the improvement is immediate. Any remaining tumor beyond
the confines of the surgical field can be safely treated by other standard
therapies (e.g. radiation therapy).
Medium sized tumors: Still within the confines of the pituitary gland.
As with the Cushing's tumors, the tumor can be completely removed and the gland saved for normal function.
A 'Hold' on the Surgery
Prolactinomas: Should always be treated
initially with medication (anti-DOPA agents such as Parlodil, Bromocriptin, etc.).
Even large tumors that most need to be treated by either surgery or radiosurgery
should be pretreated with these drugs to shrink the tumor away from vital brain
structures before surgery should be contemplated.
Microprolactinomas: Surgically, nothing need be done for as long as
possible. Some of these tumors appear to just sit there for years, even decades.
Extremely large tumors that cause little visual or other brain problems: In treating
these tumors, particularly in older people, the physician should consider radiation therapy to
stop the progression of these tumors. A surgical cure is usually not an option, for the
substantial surgical risk entailed.
This information found at
The presence of a pituitary tumor is most
readily determined by magnetic resonance imaging, although it may also be established by
radiographic studies including skull films, tomograms, and computer tomography.
Appropriate endocrine studies will help exclude non-pituitary causes of Cushing's
syndrome. Pituitary tumors are commonly classified according to cell type. One
staging system that is used for pituitary tumors is Leavens.
TREATMENT OPTION OVERVIEW
Treatment depends on the type of
pituitary tumor and whether it extends into the brain around the pituitary.
hormone-secreting tumors may be treated with surgery or radiation therapy. Drug
therapy with bromocriptine has been used with success in patients with
prolactin-secreting tumors. Growth hormone-secreting tumors can also be treated
by somatostatin analogues, such as Sandostatin, with success.
of transsphenoidal hypophysectomy represents a major development in the safe surgical
treatment of both hormonally-active and non-functioning tumors. Transsphenoidal surgery
is the usual treatment of choice for lesions confined within the sella turcica.
Lesions extending beyond the confines of the pituitary are most frequently the
non-functioning chromophobe adenomas and require additional radiation therapy. Rapid
deterioration of vision is an immediate indication for surgery (to relieve pressure
produced by the growing tumor mass).
The natural history of GH-secreting and
ACTH-secreting pituitary tumors is usually one of slowly progressive enlargement.
Prolactin-secreting tumors, however, often stabilize and may improve with time,
although some of these tumors may grow beyond the confines of the sella turcica.
PROLACTIN-PRODUCING PITUITARY TUMOR
When the pituitary tumor secretes prolactin, treatment
will depend on tumor size and the symptoms which result from excess hormone production.
Combinations of the above.
Bromocriptine has been used with considerable benefit in the treatment of prolactin-secreting
tumors, along with surgery and radiation therapy. The drug CV205-502 given once daily has
been used successfully with minimal side effects in relapsing or refractory cases after
This information found at
Approximately 44 percent of all primary
brain tumors are benign.
Unlike most benign tumors found elsewhere in the body, benign brain tumors
may recur and may result in death.
Currently, brain tumors cannot be prevented because their cause is still
Brain tumors are difficult to treat. Surgery and radiation therapy are
effective but limited, due to the risk each places on the surrounding normal
brain tissue. Chemotherapy has had only minimal success.
A "good" surgical
result can still leave the patient with severe physical incapacity.
"Successful" radiation therapy to the brain can have deleterious long-term side effects
In most parts of the body, benign tumors are not particularly harmful.
This is not necessarily true in the brain. Because the brain is housed within
the rigid, bony confines of the skull, any abnormal growth can place pressure
on sensitive tissues and impair functions.
Also, any tumor located near vital
brain structures can seriously threaten health. A benign tumor growing next to
an important blood vessel in the brain does not have to grow very large before
it can block blood flow.
Or, if a benign tumor is found deep inside the brain,
surgery to remove it may be very risky because of the chances of damaging
vital brain centers. On the other hand, a tumor located near the brain's
surface can often be removed surgically.
How are Brain Tumors Diagnosed?
Research has made major strides in the
ability to detect and diagnose brain tumors. When a doctor suspects a brain
tumor because of a patient's medical history and symptoms, they can
turn to a number of specialized tests and techniques to confirm the diagnosis.
However, the first test is often a traditional neurological exam.
Neurological Exam: A neurological exam checks
eye movement; eye reflexes and pupil reactions; reflexes; hearing;
sensation; movement; balance and coordination.
The next step in diagnosing brain tumors often involves special
imaging techniques and laboratory tests that can detect the presence
of a tumor and provide clues about its location and type.
Computed Tomography (CT): CT uses a sophisticated
X-ray machine and a computer to create a detailed picture of the body's
tissues and structures. Often, doctors will inject an iodine dye into the
patient before performing a CT scan.
The dye, also called contrast material,
makes it easier to see abnormal tissue. A CT scan often gives doctors a good
idea of where the tumor is located and can sometimes help them determine the
tumor's type. It can also help doctors detect swelling, bleeding and other
associated conditions. In addition, CT scans can help doctors check the
results of treatment and watch for tumor recurrence.
Magnetic Resonance Imaging (MRI): MRI uses a
magnetic field rather than X-rays, and can often distinguish more accurately
between healthy and diseased tissue. MRI gives better pictures of tumors
located near bone than CT, does not use radiation as CT does, and provides
pictures from various angles that can enable doctors to construct a three-dimensional
image of the tumor. Contrast material is often injected as in CT.
The pituitary gland, a small oval-shaped
structure located at the base of the brain, releases several chemical messengers
known as hormones, which help control the body's other glands and influence the
body's growth, metabolism, and maturation.
Tumors that affect the pituitary gland
account for about 10% of brain tumors. Doctors classify pituitary adenomas into
two groups-secreting and non-secreting.
Secreting tumors release unusually high
levels of pituitary hormones, triggering a constellation of symptoms, which can
include impotence, amenorrhea, galactorrhea, abnormal body growth, Cushing's syndrome,
or hyperthyroidism depending on which hormone is involved. Surgery or the drug bromocriptine
is used to treat prolactin secreting pituitary adenomas while larger, non-secreting adenomas
are treated with surgery and radiation therapy.
This information from http://www.tbts.org/
Treatment With Bromocriptine / Dostinex:
Bromocriptine (Parlodel) and Dostinex (Cabergoline) are used in the
treatment of pituitary adenomas (especially hyperllrolactinemia and acromegaly).
Bromocriptine is now considered less effective for this purpose - short term side
effects tend to be nausea, headache, vertigo, fatigue and abdominal complaints.
Dostinex - short term side effects tend to be
nausea, dizziness, sleepiness, headache, or stuffy nose.
*I took Bromocriptine at first, but now take a low dose of Dostinex, it works
This info from