What are the Treatments & FAQ

Pituitary adenomas, recently renamed PitNETs (Pituitary Neuroendocrine Tumors), are benign tumors that develop from the pituitary gland—a gland located beneath the brain in a bony cavity called the sella turcica. As the true "conductor" of the hormonal glands, the pituitary regulates numerous bodily functions.

Definition and Classification

The management of adenomas is specialized and multidisciplinary. When surgery is indicated, the expertise of the neurosurgeon is essential. In an expert center, the outcome is favorable in the vast majority of cases. Hormonal assessment (blood test) allows classification of the adenoma into two main categories:

Secreting Adenoma

Excessive secretion of a pituitary hormone:

Prolactin → Prolactinoma
ACTH/Cortisol → Cushing's Disease
GH/IGF-1 → Acromegaly

Non-Functioning Adenoma

Absence of hormonal hypersecretion. The therapeutic strategy differs according to the volume and relationship of the lesion with neighboring structures, particularly the optic pathways.

According to their size, they are classified as:

Microadenomas (diameter < 1 cm)—often present with hormonal secretion issues (Cushing's disease, acromegaly, prolactinoma)
Macroadenomas (diameter ≥ 1 cm)—primarily pose a mass effect with risk of compression of the visual pathways

Frequency

Pituitary adenomas represent approximately 15% of intracranial tumors in adults. Their prevalence is estimated between 1/1,000 and 1/1,300 in the general population, with an incidence of approximately 1/100,000 inhabitants per year. Adenomas causing Cushing's disease or acromegaly are rarer and require highly specialized management.

In the vast majority of pituitary adenomas, the causal mechanism is not currently known.

Pituitary adenomas may be discovered incidentally during brain imaging performed for another reason. When they cause clinical signs, they can produce 3 main types of symptoms depending on their secreting nature and size.

1. Symptoms Related to Excessive Hormonal Secretion

These symptoms occur only if the adenoma is secreting.

Cushing's Disease—Corticotroph Adenoma

Hypersecretion of ACTH stimulating adrenal cortisol production:

Weight gain predominantly in the face and trunk, obesity
Round, red face (facial erythrosis)
Hump at the back of the neck ("Buffalo Neck")
Excessive hair growth (hirsutism), stretch marks, skin fragility
Muscle weakness in the lower limbs—difficulty standing up, climbing stairs
High blood pressure, diabetes
Irritability, mood disorders, or even psychiatric disturbances

Acromegaly—Somatotroph Adenoma

Hypersecretion of growth hormone:

Progressive thickening of the face and extremities (feet/hands)
Thickening of soft tissues
Excessive growth of the mandible (prognathism), spacing of teeth, malocclusion
Excessive sweating, snoring, sleep apnea syndrome
Joint pain, carpal tunnel syndrome
High blood pressure, diabetes

Prolactinoma—Lactotroph Adenoma

Hypersecretion of prolactin:

Absence of menstruation (secondary amenorrhea)
Milky discharge from the breasts (galactorrhea)
Sexual dysfunction (decreased libido)

Thyrotroph Adenoma (very rare condition)

Central hyperthyroidism secondary to TSH hypersecretion by the adenoma.

2. Symptoms Related to Compression of Neighboring Structures

These symptoms can occur in all types of adenomas, provided the tumor is sufficiently large.

Visual disturbances related to compression of the optic chiasm—reduced visual field, decreased visual acuity
Headaches
Diplopia (double vision) and ptosis (drooping eyelid)—related to compression of oculomotor nerves in the cavernous sinus; rare signs, most often suggesting necrosis or bleeding within the tumor

3. Symptoms Related to Compression of the Pituitary Gland

Compression of the healthy pituitary can lead to insufficient hormone secretion (hypopituitarism), generally manifesting as: fatigue, pallor, thin skin, sexual dysfunction.

Corticotroph insufficiency (cortisol deficiency)—the most dangerous, with life-threatening risk in case of decompensation: asthenia, low blood pressure, digestive disorders
Thyrotroph insufficiency (thyroid hormone deficiency)—pallor, weight gain, constipation, depression
Gonadotroph insufficiency (sex hormone deficiency)—hypogonadism: absence of puberty, amenorrhea, decreased libido, impotence, infertility
Somatotroph insufficiency (growth hormone deficiency)—in children: growth retardation

In the presence of these symptoms, clinical analysis points toward pituitary pathology. If suspected, a hormonal assessment is performed as a priority. When the suspicion is confirmed, the reference radiological examination is pituitary MRI.

In the presence of endocrine, neurological, and/or ophthalmological symptoms, a brain/pituitary MRI is prescribed to confirm the diagnosis. The complete workup is based on three complementary components.

1. Endocrine Assessment (Pituitary Function Tests)

A blood test is performed to measure pituitary hormones and their targets:

Prolactin—TSHus—T4L—T3L—FSH—LH—Estradiol—Progesterone—Testosterone—ACTH—Cortisol—IGF-1

Detect hormonal excess—suggestive of a secreting adenoma
Identify hormonal insufficiency related to compression of the healthy pituitary

An endocrinology consultation completes the management: specific treatment for secreting adenomas, or hormone replacement therapy in case of deficiency.

2. Radiological Assessment

Pituitary MRI is the reference examination. It provides detailed analysis of adenoma extensions:

Within the sella turcica—relationship with the pituitary gland
Suprasellar extension—relationship with the chiasm and optic nerves
Infrasellar extension—toward the sphenoid sinus
Lateral extension—toward the cavernous sinuses

Depending on the case, a CT scan (angio-CT, bone windows) may supplement the evaluation and be used for neuronavigation to guide surgery.

3. Ophthalmological Assessment

This assessment is often necessary due to the proximity of the visual pathways. It typically includes:

Visual acuity measurement
Visual field examination
Fundoscopy and/or OCT as indicated

The therapeutic strategy is discussed in a Multidisciplinary Team Meeting (MDT) bringing together neurosurgeons, endocrinologists, radiologists, and depending on the case, pathologists, biologists, and radiation oncologists.

Therapeutic options

MRI surveillance—justified for small, stable, and asymptomatic non-functioning adenomas
Medical treatment—first-line for most prolactinomas and certain secreting adenomas, initiated by the endocrinologist
Surgical resection via endonasal (endoscopic) approach—indicated for secreting adenomas (Cushing's disease, acromegaly, resistant microprolactinomas) and large non-functioning adenomas compressing the visual pathways, showing progression on MRI, or in case of failure/intolerance to medical treatment
Radiotherapy / Radiosurgery—very rarely as first-line treatment; indicated depending on context (postoperative residuals, aggressive adenomas)

Endoscopic Endonasal Surgery

Objective

The objective is to achieve the widest possible resection while preserving normal endocrine functions. In case of lateral extension (cavernous sinus invasion), a residual is most often left in place to limit operative risks. For a secreting microadenoma without cavernous invasion, the objective is complete resection leading to remission.

Why the Endoscopic Approach?

The mononostril endoscopic endonasal approach is now the reference technique, having replaced the microscopic technique in expert centers. The endoscope brings light deep into the nasal cavities and provides a panoramic view (sella, suprasellar and infrasellar regions, cavernous sinus), improving resection of extensions. This minimally invasive approach respects the nasal cavities, reduces rhinological consequences, and improves postoperative comfort.

Who Will Care for You?

Neurosurgeon

Establishes the connection between your symptoms and the lesion
Explains the principles of the procedure and resection objectives
Explains operative risks
Organizes the care pathway and postoperative follow-up
Provides follow-up in coordination with the referring endocrinologist

Endocrinologist

Diagnoses hormonal excesses or deficiencies
Prescribes hormone replacement therapy if necessary
Prescribes antisecretory treatment when indicated
Provides follow-up in coordination with the referring neurosurgeon

Anesthesiologist

Mandatory preoperative consultation to assess your general health and adapt anesthetic management.

Operating Room and Ward Teams

The surgical and anesthetic team in the operating room, as well as the nursing staff in the ward, ensure your care throughout your stay.

Frequently Asked Questions

The following answers are provided for informational purposes and may vary depending on each patient's clinical and radiological situation.

Admission date—the day of surgery
Duration of surgery—approximately 1 hour 15 minutes
Length of hospital stay—3 days
Operative risks—overall complication rate in our experience: 1.5% (hematoma, infection, cerebrospinal fluid leak that may require reoperation)
No intranasal packing—minimally painful procedure
Nasal discomfort for approximately 1 month (sensation of nasal obstruction)
Do not blow your nose for 3 weeks
Air travel permitted starting 1 month after surgery
Return to sports permitted after 6 weeks

Guide

Prospective Patients

Your stay is our priority, and we have established a patient pathway program for your surgical schedule, admission and intervention, through to your discharge. Please do not hesitate to contact us if you have any questions.

Your stay