Neurosurgeon Questions Pituitary Disorders

Is pituitary adenoma life-threatening?

I am due to undergo a surgery for my back, however I have been detected with pituitary adenoma which is becoming a constraint to proceed with the surgery. Is pituitary adenoma a life threatening conditioning?

10 Answers

Pituitary adenomas are most often benign, but their secretion, if any, as well as mass effect on the optic apparatus need to be evaluated.
Usually not. If you have hormonal dysfunction then this can be corrected medically and surgically.
Pituitary adenoma are very benign tumors. However, you must pay attention to it and be cared for by someone with a specialty interest in the area. Often, pituitary adenomas require surgery eventually, but some can be treated with medication without the need for surgery. If they are small, we often will follow them and they do not require surgery immediately. Adenomas that make extra hormones can be life-threatening because of hormone excess. In addition to the MRI, hormone labs are needed as part of the assessment. Vision problems are common due to pressure on the optic nerves.
The pituitary adenoma can be a serious condition if it is secreting hormones that can cause serious medical conditions or can cause serious and life threating conditions if large enough. Most tumors are found while small enough to be safely treated with medication or trans sphenoidal surgery. A good workup of your case would answer the question of how much of a problem the tumor is in your case.
There are several types of pituitary adenomas. All potentially can be life threatening if not treated properly. Many can secret excess hormones which can cause metabolic, cardiac and endocrine abnormalities. Some tumors can actually grow and potentially bleed with devastating effects such as blindness and coma. So it is important that the tumor is worked up by an endocrinologist and neurosurgeon to determine the tumor type and the appropriate treat plan prior to having back surgery.
Pituitary adenoma is seen in 25% of the population and the main concern with them is visual deficit or hormonal abnormalities, esp those related to cortisol or growth hormone producing tumors, but they can also have other hormonal abnormalities in the form of deficits that can be replaced by medications, however, some very aggressive prolactinomas may be very large and cause hydrocephalus which, if significant enough, may be life-threatening, but this is usually detected way earlier before it reaches this state.
Pituitary tumors are mostly benign (with very few exceptions) and hardly ever life threatening. Small tumors are found either because they produce excess hormones or can be found by accident on a scan. For tumors producing hormones, the first line of treatment is medical if it is the kind of hormone that can be suppressed. Lager tumors can present with visual loss from pushing on the nerves for vision. If those tumors produce hormones, medical treatment can come first but many larger tumors do not produce hormones and treatment is surgical through the nose to preserve vision. I am not sure how any of this would impact your back surgery, on the other hand I am not a big believer in back surgery and think most is not indicated and eventually makes people worse.

It is difficult to summarize in a brief answer all the details about pituitary adenomas. A pituitary adenoma is a benign tumor of the pituitary gland. In some patients, it is a small, incidental finding and of no consequences. In other patients, even though it is small, it may be serious because it leads to changes in the hormone balance of the body--these kinds of tumors require medical and/or surgical treatment depending on the type of hormone involved. Finally, in other patients, the pituitary tumor is large and can cause other symptoms of which visual impairment is the most important. Bottom line: discuss with your doctor to learn more about what type of pituitary adenoma has been detected and what, if any, treatment is necessary.
Pituitary adenoma can be either functional (secreting hormones) or non-functional (not secreting hormones). Functional adenomas may need to be treated first as some cause complications with any surgery depending on the hormone it is secreting. Non-Functioning adenoma is most often found incidentally and should not be problematic until it becomes large enough to exert pressure on your optic nerves and effect your vision. You should have your vision evaluated first prior to the back surgery. If the tumor is already effecting it, then it needs to be taken care of first. Otherwise, if small enough, it shouldn't influence your back surgery.