Pituitary Adenoma

What is a pituitary adenoma?
Pituitary adenomas are benign, slow-growing tumors that arise from cells in the pituitary gland. The pituitary gland is located at the base of the brain, just behind the eyes.
Pituitary adenomas are divided into microadenomas (less than 1 centimeter in size) and macroadenomas (1 centimeter or greater in size), secretory and non-secretory. Their treatment requires a multidisciplinary approach, which includes a team made up of an endocrinologist, an ENT specialist, a neurosurgeon, an ophthalmologist, a neuroradiology specialist and an internal medicine specialist.

When is treatment necessary?
Treatment (pharmaceutical or surgical) is necessary to correct excess hormone secretion, bring the pituitary gland function back to normal, and stop the tumor from spreading, while at the same time restoring or maintaining visual acuity or the visual field and achieving full diagnosis. Not all pituitary adenomas require surgery.

When is surgery necessary?
The most common indication for surgery is a reduction in visual acuity or the visual field, or when the tumor presses on the optic chiasm. Other signs indicating surgery include: faster growing tumors, ACTH-secreting tumors (Cushing’s disease), acromegaly-causing tumors, prolactin-secreting tumors (rare) or when the patient cannot tolerate the pharmaceutical treatment. The method of choice for most pituitary adenomas is full endoscopic transsphenoidal resection. This is the least traumatic approach towards the sella turcica. It avoids visible scars, provides excellent visualization of the pituitary gland and its pathology, has lower morbidity and mortality compared to open approaches, and requires shorter hospitalization.
Some pituitary adenomas may spread to the suprasellar region and may invade the cavernous sinus, compressing the carotid artery. These require an extended endonasal approach, such as transpterygoid, transtuberculum or transplanum.

Endoscopic Approach
The endoscopic approach is the method of choice for pituitary adenomas, with fewer complications compared to the microscopic approach (lower chance of diabetes insipidus and CSF leakage) and shorter hospitalization.