Brain
Pituitary Gland Tumors Are Often Misdiagnosed
By Rush University Medical Center
May 1, 2005, 21:04

A recent study found that tumors of the pituitary gland are more common than many health care professionals realize, with national prevalence rates averaging 16.7 percent.

To neurosurgeon Dr. Gail Rosseau, this isn't surprising.

Rosseau, who treats patients with a variety of neurological conditions at Rush University Medical Center and the Chicago Institute of Neurosurgery and Neuroresearch (CINN), says that pituitary tumors are often misdiagnosed because of the confusing array of symptoms they present.

"Conditions such as osteoporosis, sexual dysfunction, depression, infertility, or growth disorders can be the result of abnormalities in the pituitary or "master" gland at the base of the brain. Many times this association is overlooked," Rosseau said.

"These types of tumors are generally not malignant, but they have many different and highly variable ways of making their presence known, "she said. "If misdiagnosed or untreated, they may progress, causing blindness, heart disease or in the worst cases, premature death."

Because the disease is complex, Rosseau saw the need for a patient education association in the Chicagoland area. The Greater Chicago Pituitary Education Association was founded in late 2004 and is underwritten by a grant from The CINN Foundation. Each quarterly meeting of the Association provides an educational presentation from a member of the Chicago medical community involved in the treatment of pituitary disease. The Association aims to include physician speakers ranging from endocrinologists, to neurosurgeons, to ear, nose and throat specialists and bridge institutional alliances.

The next meeting will take place at 6:30 pm on Tuesday, May 3 at The Neurologic & Orthopedic Institute of Chicago, 4501 N. Winchester, ground level.

Many patients are concerned about treatments and surgery because of the location and function of the pituitary. The pituitary is a small, pea-sized gland located at the base of the brain that functions as "The Master Gland." It releases stimulating hormones that signal the thyroid gland, adrenal glands, ovaries and testes, directing them to produce their respective hormones. These hormones have dramatic effects on metabolism, blood pressure, sexuality, reproduction, and other vital body functions. In addition, the pituitary gland produces growth hormone for normal development of height and prolactin for milk production.

CINN psychologist Dino Kostas said pituitary tumor patients have unique concerns, such as loss of vision, that require a different approach. He emphasized that an educational seminar is a great way to allay patient fears while allowing patients to ask questions of anyone on the treatment team.

"Most patients contemplating surgery have fears and concerns about the surgery, but with our patients, we see a heightened level of anxiety about the potential loss of vision because the pituitary gland is so close to the optic nerve," Kostas said. "Frequently, we talk to many patients who are also fearful that they will have decreased libido or become infertile."

Treatment depends on the type of pituitary tumor, the extent to which it has invaded the brain, as well as the patient's age and general health. Treatment is most effective when diagnosis is early, and it typically involves surgery, radiosurgery, and/or drug therapy, Rosseau said.

Ear, nose and throat surgeon Dr. Steven Becker, said that he is able to calm many anxious patients because surgical techniques have vastly improved in the last decade and recovery times are typically one month, down from more than two months previously. Becker has performed approximately 600 of these surgeries.

"As recently as 10 years ago, surgeons would use a craniotomy, which requires an incision under the lip and a full elevation of half the facial tissues to access the nasal interior," he said. "Now, we use an endoscopically assisted approach to access the pituitary gland during the two and half hour surgery. This approach allows surgeons to go up the nasal cavity in a minimally invasive manner," Becker said.

He stressed that surgical candidates are typically those with a past history of sinusitis, or nasal trauma. Becker said that patients who attend the educational forum tend to make for better patients because they ask good questions and the forum helps lessen the anxiety they feel.

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