Neurosurgery - Patient Care and Treatment

Learn about testing for and treating many kinds of pituitary tumors from the Pediatric Neurosurgery team at Penn State Children’s Hospital.

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Pituitary tumors

Childhood pituitary tumors, although rare, do occur. They are usually benign (not cancer). However, the pituitary gland plays an important role in regulating hormones. Even a small disruption can have serious effects on:

  • Mood
  • Focus and concentration
  • Growth
  • Overall maturation

Pituitary tumors can also cause symptoms due to pressure on other parts of the brain. They may cause:

  • Headaches
  • Dizziness
  • Vision problems

Pituitary tumor symptoms

Usually, pituitary tumor symptoms are related to a specific hormone or group of hormones. They may affect the hormone’s role in health and development. Symptoms vary depending on:

  • The tumor size
  • The tumor location
  • Whether it presses on other organs
  • Whether it affects hormone secretion

For instance, pituitary tumors may press on the optic nerve, causing vision problems.

The symptoms of a pituitary tumor can range from simple common complaints such as listlessness or restlessness to more severe symptoms such as headaches, vomiting or dizziness. One challenge in diagnosing pituitary tumors is that every child has minor symptoms such as restlessness or headaches from time to time.

Of course, when a child has more distressing signs or multiple symptoms, parents and doctors search for answers. More precise tests are recommended.

Pituitary tumors that affect hormones

In older children or adolescents, other pituitary tumor signs may include problems with normal growth and development.

  • Sometimes girls or boys younger than age nine have a very early puberty (called precocious puberty). This is caused by tumors that secrete luteinizing hormone (LH).
    • Girls may develop breasts, have pubic hair and begin menstruation (periods).
    • Boys may find their genitals enlarging, and facial and pubic hair beginning to grow.
  • Tumors that secrete follicle stimulating hormone (FSH) can delay sexual development in both sexes and stunt growth.

If the tumor limits the secretion of gonadotropin, it can affect the development and function of the ovaries and testes.

  • Adolescent boys may fail to enter puberty, or may lose facial or pubic hair and notice an effect on their genital size.
  • Adolescent girls may also fail to enter puberty or may find their breasts smaller, some loss of pubic hair, and perhaps an interruption of menstruation (skipped or stopped periods).

Where secretion of adrenocorticotropic hormone (ACTH) is low, the child may have:

  • Low blood sugar
  • Fatigue
  • Low blood pressure, which can cause dizziness when standing

When pituitary tumors secrete ACTH, it can cause a variety of problems, including:

  • Stunted growth
  • Delayed or stopped puberty
  • Weight gain
  • Acne
  • Purple streaks in the skin
  • A round, red face
  • A bulge of fat on the back of or below the neck
  • Weakness
  • Depression
  • Forgetfulness
  • Sudden partial or complete vision loss

Some pituitary tumors can secrete thyroid stimulating hormone (TSH), disrupting the function of the thyroid gland. This enlarges the thyroid, causing a visibly large lump in the neck known as a goiter. These tumors also cause:

  • Nervousness
  • Rapid pulse
  • Weight loss
  • Excess eating and sweating
  • Sensitivity to heat

Pituitary tumors that limit TSH secretion can also affect a child in many ways, including causing:

  • Trouble concentrating
  • Tiredness
  • Constipation
  • Dry skin
  • Sensitivity to cold
  • Irregular periods or none at all

Some pituitary tumors lower the secretion of vasopressin, the hormone that triggers the kidneys to reabsorb water from urine. Lack of vasopressin can cause:

  • Extreme thirst
  • Excess urination
  • Big appetite with emaciation (being overly thin)
  • Loss of strength
  • Fainting

Other pituitary tumors secrete too much of the hormone prolactin.

  • In girls who have gone through puberty, tumors that secrete prolactin can cause them to produce breast milk and stop menstruation.
  • In boys who have gone through puberty, it can cause impotence (erectile dysfunction or ED).
  • Too much prolactin can also delay or stop puberty in both sexes.

A pituitary tumor that limits the secretion of growth hormone (GH) can stunt growth and cause low blood sugar, which can lead to fainting, dizziness, anxiety and intense hunger.

Pituitary tumors that secrete GH can boost growth excessively. If not treated, the children can grow unusually tall.

In adolescent children who have gone through puberty, and whose bones have stopped growing, excess GH can cause:

  • Acromegaly (enlarged feet, hands, lips, nose and jaw)
  • Excessive sweating and fatigue
  • Widened spaces between the teeth
  • Furrows in the forehead
  • Weakness in the hands

Craniopharyngioma

The most common type of pituitary tumor in children is called craniopharyngioma. It happens when embryonic remnants grow the area of the pituitary gland. This tumor often presses on the optic nerve, causing vision problems.

Craniopharyngiomas also cause a lack of most pituitary hormones. That means a child may have a combination of symptoms described above for tumors that cause low single pituitary hormones.

Testing for pituitary tumors

Doctors can see larger pituitary tumors on an X-ray, computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan. Many pituitary tumors, however, are too small to be seen on these images.

To diagnose smaller tumors, doctors may test different hormone levels. One way to check hormones is to give a child a substance that stimulates or suppresses certain hormones, then test the child’s blood or urine within a few hours. For example, a child may have a glucose (blood sugar) tolerance test where:

  • After fasting (not eating) overnight, the patient drinks a sugar solution.
  • Blood samples are then taken to measure blood sugar or growth hormone.

If a child has a very small pituitary tumor, he or she may need an invasive procedure called an inferior petrosal sinus sampling to find it.

  • A radiologist inserts special catheters from the groin veins into the vessels that drain the pituitary gland at the top of the neck.
  • Blood is drawn to measure the hormone that the tumor secretes.

Treating pituitary tumors

The treatment plan for pituitary tumors varies according to the type and size of the tumor. Doctors can successfully treat most pituitary tumors with:

  • Microsurgery (performed with a surgical microscope)
  • Radiation therapy
  • Surgery
  • Medications
  • A combination of these treatments

Surgery is usually recommended for tumors that grow quickly and threaten vision.

Your child’s doctor will recommend treatment for your child’s specific diagnosis. Sometimes treatments stimulate or compensate for missing hormones. Others reduce hormone production. In some cases, children need to take medicine every day.