Pituitary Tumor Center
We offer expert treatment for prolactinomas, growth-hormone secreting adenomas, pituitary-based Cushing's disease, and other pituitary tumors. Neurosurgeon Viviane Tabar (right) and nurse Lystra Swift check equipment in one of the center's surgical suites.
The Pituitary Tumor Center at Memorial Sloan-Kettering, which is the only center of its kind in the New York City area, was established to enable our experts to more closely collaborate in the treatment of patients with tumors of the pituitary gland and hypothalamus (the area of the brain that controls body temperature, hunger, and thirst).
For information about our expertise, see the sections below.
About Our Center
When a patient comes to our Pituitary Tumor Center, he or she can see multiple doctors from the treatment team — on the same day if needed. In addition, our Pituitary Tumor Center team holds regular meetings to discuss how to best treat more complex cases and to review all cases, evaluate progress, and determine next steps.
We also treat patients with other tumor types that arise in and around the depression of the bone at the base of the skull — called the sella turcica — where the pituitary gland is located. These include meningiomas, craniopharyngiomas, chordomas, and other tumor types.
Our Approach & Expertise
Our multidisciplinary approach to the treatment of pituitary tumors allows neurosurgeons, endocrinologists, neuro-ophthalmologists, skull base surgeons, radiation oncologists, and neuroradiologists to work together as they devise an individualized treatment plan for each patient. State-of-the-art diagnostics — including intraoperative MRI, imaging, hormone testing, and visual field testing — combined with surgery, radiation therapy, and medication are used to ensure that patients receive the most sophisticated care available.
Advanced Imaging Technology
Tumors of the pituitary gland are often difficult to diagnose, and some go undetected for a person's entire lifetime. Many of these tumors never cause symptoms and are only discovered through imaging studies conducted for an unrelated health issue. Others cause a range of symptoms — such as headaches, nausea, and vision problems — that can be attributed to other diseases, so the diagnosis of a pituitary tumor is often overlooked.
At Memorial Sloan-Kettering, where MRI is used regularly to diagnose and monitor tumor growth, we have special expertise in the use of this technology to diagnose pituitary tumors. MRI is the best imaging technique for pituitary tumors because the technology can identify even the tiniest growths — including microadenomas, which are small pituitary tumors less than one centimeter (nearly 1/2 inch) in size. Contrast-enhanced MRI scans have become particularly useful in making accurate diagnoses of all types of brain tumors, including those in the pituitary gland. CT is also used to find pituitary tumors, but far less commonly than MRI.
Intraoperative Imaging Suite
Memorial Sloan-Kettering is one of a few hospitals in the country that has an intraoperative imaging suite equipped with a high-field strength MRI scanner in the operating room. This technology allows the surgeon to check if a tumor has been removed entirely while the patient is still under anesthesia. Performing pituitary tumor surgery in this setting enables a greater degree of precision and helps reduce the need for a second surgery.
Dynamic Pituitary Testing
The pituitary gland is often called the “master control gland” because it regulates the activity and function of most other glands in the body. The primary hormones produced by the pituitary gland are adrenocorticotropic hormone, growth hormone, prolactin, thyroid-stimulating hormone, follicle-stimulating hormone, and luteinizing hormone. (For information on each hormone's role within the body, visit About Pituitary Tumors.)
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Intra-Operative Imaging Suite To improve the success of brain surgery, Memorial Sloan-Kettering’s neurosurgeons perform brain surgery in an intra-operative imaging suite that has a magnetic resonance imaging (MRI) scanner in the operating room
To determine if the pituitary gland is functioning correctly, measurements of the hormones it produces are taken. This is a complicated process in which hormones are assessed using a variety of tests that add, block, or remove hormones from the bloodstream. This is known as dynamic pituitary testing. Our endocrinologists perform these tests to aid in diagnosis as well as to measure pituitary function before and after surgery. The tests can also help physicians devise a plan of treatment. The type of treatment depends upon whether the tumor is functional and, if so, which hormone it secretes. Treatment options may include surgery, medication, and radiation therapy, either alone or in combination.
One important function of the pituitary gland is the ability to secrete, or release, excess hormones in times of stress. Examples of this are when the body is fighting infection or when a person needs to elevate his or her blood pressure quickly. This function is called “reserve capacity.” Determining the pituitary gland's reserve capacity for specific hormones is one of the main reasons for performing dynamic pituitary testing.
Vision and Pituitary Tumors
The pituitary gland is located at the base of the brain, near the optic nerves, which carry signals from the eyes to the brain. Any growth in the pituitary puts pressure on the surrounding areas and specifically on a part of the brain called the optic chiasm — an X that is created from the crossing of two nerves, one from each eye, that lead to the opposite side of the brain. Compression of the optic nerves, or chiasm, can result in a change in one's vision.
Having a problem in one's visual field may be a sign of a tumor in the pituitary gland. Although change in a person's visual field usually develops very slowly, even the smallest change should be taken seriously.
Our ophthalmologists and neuro-ophthalmologists are skilled in performing and interpreting the results of visual field testing, a term that encompasses several different vision tests. These tests can detect the location and extent of vision loss and can be helpful in both diagnosis and treatment. Visual field testing can also help to monitor for disease progression and to evaluate treatment effectiveness.
Our Surgical Expertise
The primary treatment for most pituitary tumors is surgery. The surgical approach depends on the type of tumor, its location, size, and whether it has spread into nearby tissues. Our neurosurgeons often use a minimally invasive technique called transnasal transphenoidal resection to remove the tumor through an incision inside the nasal passage. Advantages of this approach are that no part of the brain is touched, the neurologic complication rate is very low, and there is no visible scar following the procedure. Some pituitary tumors grow into the skull and may require a surgery called a craniotomy, during which the neurosurgeon removes the tumor through an incision in the skull.
The majority of pituitary tumor surgeries are performed in operating rooms equipped with an MRI scanner. This technology allows the neurosurgeon to confirm that the tumor has been completely removed while the patient is still under anesthesia.
Memorial Sloan-Kettering neurosurgeons also use a minimally invasive surgical procedure called endoscopy to remove pituitary tumors. This procedure employs a thin, lighted tube with a camera on its tip (called an endoscope) that allows the neurosurgeon to see into the back of the nose and minimizes the extent of surgery within the nasal cavity.
Radiation Therapy
Radiation therapy may be used as a primary treatment for disorders in the pituitary gland, as well as for tumors that have come back, or recurred, after initial treatment. Our experts use radiosurgery and intensity-modulated radiation treatment (IMRT) to target these tumors.
Radiosurgery, or stereotaxic radiosurgery, is a type of external radiation therapy that uses special equipment to give a single large dose of radiation to a tumor. IMRT uses radiation beams of varying intensity created to match specific tumor angles and shapes so that the tumor is targeted as precisely and uniformly as possible. This helps to reduce the damage to delicate structures in the area, such as the optic nerves.
