I. General Questions About a Pituitary Tumor or Pituitary Adenoma

II. Diagnosis of Pituitary Tumor

III. Medical Treatment of Pituitary Tumors

Any medical therapy for a pituitary tumor should reduce hormone overproduction by the tumor, and, ideally, decrease the size of the pituitary tumor so that if there is a visual abnormality, this is improved. Reduction in tumor size should also improve or relieve headache associated with the tumor. Since not all pituitary tumors produce an excessive amount of a hormone or hormones, the only measure of successful medical therapy for a non hormone-producing tumor is the effect on tumor size and clinical symptoms (visual problems, headache).

A. Prolactin producing tumor (Prolactinoma):

B. Growth hormone producing tumor (Acromegaly)

C. ACTH producing tumor (Cushing's Disease):

D. Non functioning pituitary tumor:

E. Craniopharyngioma:

IV. Replacement Therapy for Hypopituitarism

Childhood and Adolescent Pituitary Disorders

Although a pituitary tumor (adenoma) is more common in adults, children and adolescents may also have this problem. The most common types of tumors in the pituitary region in this age group are a craniopharyngioma or a Rathke’s cleft cyst (developmental disorders that occur during fetal [in the womb] life but may not become obvious until later). The hallmark of any type of a pituitary problem in children and adolescents is failure to grow, slowing of the growth rate and/or failure of sexual development (puberty). This emphasizes the need to monitor growth regularly. There is a condition known as “constitutional delay of growth and puberty” that may be assumed to be the problem. Constitutional delay of growth and puberty means that during adolescence the patient does not have the expected normal growth spurt or begin puberty until age 15 or 16. Constitutional delay of growth and puberty may be “familial” meaning that there is a family history of late development, usually in a parent. However, this disorder cannot be diagnosed without appropriate hormone studies and an MRI study of the pituitary gland and brain to make sure that there is not a pituitary tumor or craniopharyngioma or Rathke’s cleft cyst causing this delay in growth or puberty.

Another cause of growth failure or delayed puberty is in children who were treated for leukemia with brain and spinal cord radiation to prevent leukemia recurrence. Brain radiation may cause pituitary gland failure that causes not only growth failure and failure to go through puberty, it may also cause thyroid failure (hypothyroidism) and adrenal gland failure (adrenal insufficiency). Children who have undergone brain radiation require regular measurement of growth and development and hormone blood tests to detect these problems.

The treatment of a pituitary tumor, a craniopharyngioma or Rathke’s cleft cyst is the same as for adults. A prolactin producing tumor is usually first treated with medication (bromocriptine, cabergoline) while all other types of tumors require surgery to remove as much of the tumor as possible. As in adults, additional treatment may be necessary including pituitary radiation and medications to control excessive hormone production and to replace any deficient hormones. Diagnosis and treatment of growth hormone deficiency is very important to restore a normal growth rate and hopefully achieve a normal predicted final height (this is also dependent on genetic and nutritional factors).

There are specific psychological and social issues in children and adolescents who have a pituitary problem. The delay in growth and/or puberty may cause emotional difficulties because of being “different” from his or her friends and schoolmates. The need to take medications, including a daily growth hormone injection, may add to a sense of being “different” or “sick”. Children and adolescents may resist the need to take medications, may become depressed and/or withdrawn because of feeling “different” or “sick”. This may have an impact on school performance, participating in sports (feeling of having an abnormal body compared with friends and schoolmates; lack of breast development in girls, lack of beard development in boys) and participating in social events (feeling too short to go to a dance). These are very important issues for these children and adolescents and must be addressed by discussing this at home, counseling in many circumstances and with appropriate hormone therapy or therapies to promote normal growth and pubertal development. Children and adolescents who require hormone treatments should be reassured that they can lead a normal life and participate in sports and social activities as long as they take their medications as prescribed.

Childhood/Adolescent Cushing’s Disease: The hallmarks of Cushing’s disease in children are weight gain and slowing or stopping of growth, resulting in obesity and short stature. It is important to measure height and weight at least once a year and plot the value on a growth chart (hopefully most Pediatricians do this). When a child has a decline in his or her growth rate, with weight gain, this needs to be evaluated. If thyroid hormone levels are normal, the child should be evaluated for Cushing’s (24 hour Urine Free Cortisol, best test).

Future fertility:Another issue that must be addressed is the possibility of being a father or mother as an adult. This concern may not be expressed by an adolescent, but it is probably a concern. If the pituitary problem has resulted in loss of pituitary function, particularly the ability to be a father or mother in the future, the issue must be discussed. Future fertility IS possible without a functioning pituitary gland. Fortunately, the pituitary hormone hormones (LH, FSH) can be administered to stimulate the testes and ovaries to produce testosterone and sperm (men) and estrogen and progesterone and production of an egg (ovulation) (women). The bottom line: it will take more “work” to restore potential fertility, but fertility is possible. A child or adolescent with pituitary failure should be told this early on to reduce anxiety and concern about a future “normal life”. It is uncommon for a child or adolescent to talk about this issue, but it is very important to address this issue when pituitary failure is diagnosed with the hope of avoiding or reducing anxiety/distress/concern about this issue. Yes, fertility is possible, but it will require treatment and time.

In adolescent boys who have gone through some of the stages of puberty, sperm production may be normal when the diagnosis of a pituitary problem is made. The only way to determine this is to have a semen analysis with measurement of the number of sperm, the sperm motility (movement) and the amount of normal sperm (percentage). If the semen analysis shows a reasonable sperm count, motility and percentage of normal sperm forms, it is wise to have the sperm “banked” (frozen) for potential future fertility. The semen analysis should be done before pituitary surgery or radiation treatment or soon afterward since future fertility cannot be guaranteed after treatment. This procedure is also recommended for adult men who may wish to preserve potential fertility.


A patient with a pituitary tumor is a challenge for the patient, her/his family and the physicians caring for the patient. Working together, the goal is to achieve the correct diagnosis, appropriate treatment(s) and ultimate outcomes that result in restoring a patient to normal function. This challenge can be met successfully with the coordinated efforts of the patient, the family and the physicians resulting in the best possible outcomes for the patient and his or her family.


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