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Many things may cause visual deterioration. One cause of visual problems that most people don’t immediately think of is a pituitary tumor. Fortunately, the vast majority of these tumors are benign (non-cancerous) and treatable, either surgically or with medication.
The pituitary gland is a small oval gland at the base of the brain located between the optic nerves (the nerves to the eyes). It produces hormones that control other glands and influences the growth of bone, sexual maturing, and general metabolism. It is about the size of a pea and weighs 0.5 g (0.02 oz.).
Tumors of the pituitary gland account for 10% of brain tumors. They can present with symptoms in one of two ways, either by the production of too many hormones (functional tumors), or by symptoms caused by the size of the tumor (usually the non-functional tumors). The functional tumors are usually diagnosed earlier and therefore tend to be smaller in size. Due to the excess production of hormones and their long-term harmful effects, it is vital that these tumors are treated surgically. The exception is a particular type of pituitary tumor called a prolactinoma, which can be successfully shrunk with medication.
The pituitary tumors that cause symptoms by their size are usually the ones that do not produce excess hormones (non-functional tumors). As the pituitary gland sits between the nerves to the eyes, when it enlarges it puts pressure on these nerves and typically causes visual deterioration such that patients have difficulty in the periphery of their vision, called bitemporal hemianopsia. Other symptoms may be caused by varying degrees of too few hormones, such as cold intolerance, low blood pressure and decreased libido. Patients may also frequently complain of headache.
Treatment of non-functional tumors is not usually necessary unless patients have symptoms. Patients are therefore followed closely with repeated eye examinations to check for visual deterioration, and repeated MRI brain scans to check for interval change in size of the tumor. If the tumor is particularly large, despite not causing symptoms, surgical removal may be considered to prevent a clinical condition called pituitary apoplexy which is caused by quick expansion of the tumor which results in a severe headache, accompanied by visual loss and other symptoms. This is a condition which requires immediate hospital admission and subsequent surgery.
Surgery for pituitary tumors involves operating through one of the nostrils, and there is no visible incision. Patients usually spend two nights in the hospital before being discharged home, and usually return to work within a few weeks.
Although treated surgically by neurosurgeons, pituitary tumors actually are not commonly diagnosed by neurosurgeons. Because of the wide range of presenting symptoms they are usually diagnosed by ophthalmologists, neurologists, endocrinologists and primary care physicians. It is important for patients to be closely managed with endocrinologists and ophthalmologists. The former are experts in managing patients with hormone disorders, keeping a check on hormone levels and making adjustments to any necessary medications as required. The latter will monitor a patient closely for visual deterioration. This vital multi-disciplinary approach to the management of patients with pituitary tumors ensures that patients with pituitary tumors obtain expert care and are treated most appropriately in a timely fashion.
Dr. Patrick Reid is a neurosurgeon practicing in West Islip and Bethpage. Dr. Reid has extensive experience treating pituitary tumors, as well as neck and back disorders. He can be reached at South Shore Brain and Spine Specialists (www.southshorebrainandspine.com) at (631) 422-5371.
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