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Pituitary Tumours

Tumours of the pituitary gland can be classified into those, which are functional or non-functional. The functional tumours produce hormones, commonly prolactin, growth hormone or ACTH. Overproduction of these hormones leads to specific clinical syndromes, which are normally detected prior to the tumour. It only takes a very small amount of tumour, commonly the size of a pea, to produce the full and very significantly dangerous diseases of Cushing's disease and acromegaly, for instance. CT and MRI scanning are used to identify these tumours. The larger tumours, which do not produce a hormone, are common in older people and tend to present with symptoms of problems with vision in that as they grow, they compress on the optic nerves and other parts of the optic system.

Collaboration with endocrinology and ophthalmology is a key in the handling of these tumours. Patients must be assessed fully by endocrinology to establish the effect of the tumour on the normal pituitary gland. Formal testing of the visual fields is a very accurate way of demonstrating progress or response to treatment of the tumour.

The treatment of these tumours will be very individualized. The larger tumours most commonly require surgery to decompress the optic apparatus. This surgery is most commonly performed utilizing the transsphenoidal technique in which the tumour is approached through the nose, not requiring exposure of the brain. In most cases, a very adequate decompression can be carried out and the patients are then followed over many years for recurrence. These are benign tumours, but they do tend to recur.

The smaller, functional tumours maybe treated primarily medically with specific drugs designed to attack the specific tumours. They are also usually very amenable to surgical removal. Each case is individually discussed and the options are fully discussed with the patient.

In the future, many of these tumours maybe primarily treated with the Gamma Knife because of its ability to focus narrowly on the tumour, preserving the tissue around it.

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