Treatment of Non-Functional Pituitary Tumors (Tumors That Don’t Make Excess Hormones)

Not all pituitary tumors need to be treated right away, especially if they’re not growing or causing problems. But large tumors and those that are clearly growing often do need treatment.

Large tumors

Large tumors (called macroadenomas) tend to cause symptoms and are most often treated with surgery. This helps get rid of the symptoms and reduces the risk of damaging tissues near the pituitary gland (like blood vessels, nerves, and the brain). Radiation therapy or radiosurgery might be done after surgery to kill any tumor cells that were left behind.

If a patient is not able to have surgery, radiation may be used as the main treatment.

MRI scans are done for many years after treatment. Eye exams and blood tests may be done, too. If there's tumor re-growth, more surgery or radiation may be used. Drug treatment is usually not helpful in treating these tumors, but medicines used to treat functional tumors may be tried. Some doctors have reported success using the chemotherapy drug temozolomide for fast-growing tumors.

Incidentalomas

These are small pituitary tumors (called microadenomas) that are seen on scans done for other reasons. They usually don’t cause symptoms because they’re not big enough to press on nearby structures and they don’t secrete high levels of any hormone.

Most of these tumors do not change, and many doctors recommend just watching them. Regular physical exams and yearly MRI scans will be done to see if they start growing. Hormone levels may be checked, too. If the does tumor start growing or causing symptoms, it can then be treated. But the important point is that people with incidentalomas shouldn’t get tests or treatments that they don't really need.

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Aghi MK, Bodach ME, Tumialab LM, et al.  Congress of Neurological Surgeons (CNS) and the AANS/CNS Tumor Section. Guidelines on the Management of Patients with Nonfunctioning Pituitary Adenomas: Introduction and Methodology. Accessed at www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_1 on October 16, 2017.

Lucas, JW, Bodach ME, Tumialab LM, et al. Congress of Neurological Surgeons (CNS) and the AANS/CNS Tumor Section.  Systematic  Review and Evidence-based Guideline on Primary Management of Patients with Nonfunctioning Pituitary Adenomas. Accessed at www.cns.org/sites/default/files/guideline-chapter-pdf/nfpa-chapter-5.pdf on October 16, 2017.

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Sheehan J, Lee CC, Bodach ME, et al. Congress of Neurological Surgeons (CNS) and the AANS/CNS Tumor Section. Management of Patients with Residual or Recurrent Nonfunctioning Pituitary Adenomas. Accessed at www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_7 on October 16, 2017.

Tampourlou M, Ntali G, Ahmed S, et al. Outcome of Nonfunctioning Pituitary Adenomas That Regrow After Primary Treatment: A Study From Two Large UK Centers. J Clin Endocrinol Metab. 2017;102(6):1889-1897.

Last Revised: November 2, 2017

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Treating Pituitary Tumors