Surgery to Remove a Pituitary Tumor
Surgery is usually the first treatment offered to patients with acromegaly. By removing the pituitary tumor (also called a pituitary adenoma) that's making too much growth hormone (GH), the symptoms of acromegaly should subside and GH levels should return to normal.
The best candidates for surgery are patients who have:
- a GH level below 45 ng/mL (ng/mL is the standard measurement for growth hormone levels) before surgery
- a tumor that is, at most, 10 mm in diameter
- a tumor that isn't too close to other key structures in the brain, such as the nerves supplying the eyes or nearby blood vessels
Goals of Pituitary Tumor Surgery to Treat Acromegaly
Removing the pituitary tumor that's secreting too much GH should alleviate the effects and symptoms of acromegaly because your body should then be producing a normal amount of GH. Getting GH and insulin-like growth factor-1 (IGF-1) back into acceptable ranges is the number one goal of surgery.
Other important goals of surgery to treat acromegaly include:
- relief of any associated symptoms: For example, if the pituitary tumor is causing headaches because it's pressing on a certain part of the brain, removing the tumor should alleviate those headaches.
- preventing the tumor from growing back: The surgeon will try to remove all of the tumor so that it doesn't recur and again cause excessive growth hormone in your body.
How Acromegaly Surgery Is Performed
To remove a pituitary tumor, a surgeon typically goes through the nose or the upper lip. Reaching through an incision and using tools specific to pituitary surgery, the surgeon will remove the tumor. The type of surgery is called transsphenoidal. The sphenoid sinus is behind the nose, and surgeons can reach this space either through the nose (transnasal) or through the upper lip (translabial).
Throughout the surgery, the surgeon will be able to see by using an endoscope, a tool with a camera on the end. It will be inserted through the incision.
The surgeon will also use magnetic resonance imaging (MRI). With intraoperative MRI, he or she will be able to quickly and easily check progress and determine if the whole tumor has been removed.
Possible Surgical Complications
As with any surgery, removing a pituitary tumor involves possible complications. Because there are many important structures in the brain, the surgeon will be incredibly careful while operating, but there may still be complications. Your surgeon will explain all of the risks of surgery beforehand. Some of the risks include:
- cerebrospinal fluid (CSF) leaks: Cerebrospinal fluid is the liquid around your brain and spinal cord. It is possible for CSF to leak through the nose if the incision doesn't heal properly. This is a very rare complication.
- damage to surrounding brain structures: The pituitary gland is quite close to other key brain structures, including the nerves supplying the eyes. During surgery, other areas of the brain may be damaged—causing, for example, vision issues.
- damage to pituitary tissue: It is possible to damage normal pituitary tissue around the tumor during the surgery. Damaged pituitary tissue may not be able to produce certain hormones; which hormone or hormones are affected depends on which part of the pituitary gland has been injured. In our article on the pituitary gland, you can learn about the various hormones the pituitary releases.
If another part of the pituitary gland is affected during surgery, you will probably have to take hormone replacements, possibly for the rest of your life. Your surgeon should fully explain the possible hormonal complications and risks. "
- meningitis: The meninges is the brain's covering. During the surgery to remove the pituitary tumor, it may be exposed to bacteria or a virus that causes an infection, also known as meningitis. This is a very rare complication.
- death: This is very rare, and it's even less likely to occur in otherwise healthy individuals.
Important Acromegaly Surgery Note
It's important to maintain realistic expectations when going into surgery for acromegaly. Your surgeon will explain what you can expect from the surgery and what the goals are. It is possible, even after surgery, that your GH levels won't be normal and that you may still have some symptoms of acromegaly.
Talk through the entire procedure with your surgeon. Ask any questions that you have so that you understand what will happen before, during, and after the surgery to remove the pituitary tumor that's causing your acromegaly symptoms.
- American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly. Endocr Pract. 2004;10(3):213-225.
- Acromegaly page. National Endocrine and Metabolic Disease Information Service Web site. Available at: http://endocrine.niddk.nih.gov/pubs/acro/acro.htm. May 2008. Accessed November 3, 2010.