Pituitary Gland

The pituitary gland, also called hypophysis, represents the hormonal control centre of the human body. Superior hormones from the brain pass by the pituitary stem to the hypophysis and control its hormonal production. Those hormones are released into the bloodstream and take effect on other hormon-producing organs, such as the thyroid and parathyroid glands, the adrenal glands, ovaries or testicles.

Tumors of the pituitary gland are almost exclusively benign. They grow slowly and are noticed because of either hormonal malfunction or compression of neighbouring structures like the optic chiasma.

Symptoms

Tumors that are smaller than 1 centimetre are called microadenomas. Larger tumors, the so-called macroadenoma cause a slowly increasing pressure on the gland itself, leading to a corresponding malfunction. Typical symptoms are a decrease in general performance, fatigue, exhaustion, an increased need for sleep, impotence or loss of libido. Hormone-producing tumors of the hypophysis manifest themselves as endocrinological defects. Because of the corresponding clinical symptoms, those tumors are generally discovered early on, even if they are still very small.
The continued growth of the tumor into the cranial cavity puts pressure on the optic chiasma and causes a typical visual impairment.

Therapy

Depending on the size and location of the tumor, increase or decrease in hormonal production, as well as age and symptoms of the patient, our medical centre offers three general methods of treatment:

• • waiting observantly with regular MRI-checks to control the course of the disease
  • Endoscopic removal of the tumor
  • Medicinal therapy

In recurrent tumors, another option can be discussed:

• • Stereotactic and conformal irradiation of the tumor

The majority of tumors of the pituitary gland are treated with an operation. In most neurosurgical clinics, microsurgical access is established and the cranial base is reached through relocation of the nasal septum. Despite stretching the nasal cavity using a nasal speculum, the visibility of the operational area is significantly impaired. The surgeon can hardly judge the marginal areas of tumor tissue. Without direct visibility, he risks injuring important structures, such as the optical nerve and carotid arteries.

In our centre however, tumors of the pituitary gland are operated entirely endoscopically through the nose. This innovative method allows for better visibility and control during every step of the operation. Oftentimes, this enables the surgeon to remove the entire tumor, while treating the healthy structures with care. An uncomfortable tamponade of the nasal cavity is not necessary, which allows our patients to breathe freely through the nose after surgery.

The most modern 3D endoscopes improve lighting intensity and depth of field, showing deep-set structures very clearly. During minimally invasive surgery through the nose, we routinely use a navigation apparatus. If necessary, the effectivity of the operation is confirmed in real-time, using radiological diagnostics. This way, possibly remaining tumor parts can be identified and removed, using intra-operative CT or MRI.