Symptoms of Pituitary Tumors

The pituitary is a gland at the base of the brain responsible for regulating hormones that can control endocrine functions such as growth, metabolism, reproduction, and more. When an abnormal growth or tumor develops within or around the gland, it can damage the regular function and growth of hormone-releasing cells. In addition to handling the stress of a pituitary tumor diagnosis, patients can find it challenging to understand the symptoms a pituitary tumor can cause. 

There are various symptoms of pituitary tumor growth that a patient can experience, depending on what hormone (if any) or pressure symptoms are being secreted or caused by the tumor, respectively. The tumor may cause hormones to be overproduced or underproduced, leading to various symptoms. The symptoms can mimic other medical issues and may differ for each individual. 

Patients may initially experience a few or many symptoms of pituitary tumor growth. These include: 

• Headaches (often located in the forehead region and are a constant pain that slowly gets worse)
• Nausea
• Fatigue
• Anxiety
• Vision problems
• Weight gain
• Easy bleeding or bruising
• Menstrual irregularities
• Abnormal lactation (called galactorrhea)
• Erectile dysfunction
• Heat or cold intolerance

Please note that most people with headaches do not have a pituitary tumor and headaches are rarely the sole presenting symptom of a pituitary tumor. Therefore, any surgical treatment for a small pituitary tumor that is “thought” to only cause headaches must be considered very cautiously.

Patients can develop either functional or non-functional pituitary tumors. These have their own symptoms, depending on the hormone production affected by the tumor. Some patients may also wonder if ear or sinus problems are symptoms of a pituitary tumor. It is possible, but very rare, for a pituitary tumor to cause these symptoms.

Pituitary tumors that produce hormones are called functional tumors. The symptoms experienced are a result of the specific hormone that is overproduced. Functional pituitary tumor symptoms in females and males can present very differently. A physician will often order laboratory tests to identify any pituitary hormonal dysfunction.

A prolactinoma is caused by the overproduction of the hormone prolactin. In younger women, too much prolactin can inhibit hormones related to the menstrual cycle, causing the cycles to be irregular or stop, leading to infertility issues. A small amount of excess prolactin can cause these symptoms, so pituitary tumors in females are often smaller and detected earlier than in males.

Because average men have low levels of prolactin and don’t have menstrual periods, prolactinomas are less frequently discovered in males by symptoms alone. Too much prolactin in men can decrease testosterone, leading to fatigue, low libido, and erectile dysfunction. In rare cases, men can experience enlarged breasts and milk production.

Too much growth hormone can cause a disease called acromegaly in adults and gigantism in children. Growth hormone increases a hormone called insulin-like growth factor that can alter the shape of the body’s internal organs and bones.

Acromegaly causes enlarged hands, feet, or other structures like the jaw and forehead. There may be increased skin tags, sweating, arthritis, and sleep apnea. Men may notice that their voice becomes deeper and may notice an increase in their shoe or hat size.

Gigantism can present with many of the same symptoms along with delayed puberty. If either acromegaly or gigantism go untreated for too long, it is possible to develop high blood pressure, diabetes mellitus, and heart disease.

If the pituitary tumor produces too much ACTH, the adrenal gland will generate excess cortisol, known as the stress hormone, leading to Cushing’s disease. Patients may experience increased blood pressure, increased blood sugar, unexplained weight gain (often in the stomach region), muscle wasting, and fragile bones. There can be fat deposits in the face, back of neck, and shoulders, giving a swollen look. The condition can cause purple stretch marks on the stomach and thighs.

A pituitary tumor that produces too much TSH is very rare but can lead to hyperthyroidism because TSH increases thyroxine, a hormone that controls the body’s metabolism. Symptoms can include increased sweating, increased heart rate, hand tremors, anxiety, muscle weakness, and weight loss. Women may experience a lighter menstrual flow.

Non-functional pituitary tumors often do not produce any hormone. They are more common than functional pituitary tumors and cause symptoms due to the enlarged pituitary gland pushing on other structures in the brain, including the optic (vision) nerves.

This often causes partial vision loss and headaches. An enlarged pituitary tumor can also compress the normal parts of the pituitary gland, preventing it from producing enough hormones. For example, growth hormone deficiency can stunt puberty in children.

This deficiency is less drastic in adults but may result in muscle loss. Similarly, a reduction in ACTH can lead to fatigue and low blood pressure, while reduced TSH can cause weight gain and fatigue.

A healthcare provider may perform a physical examination to check for visible symptoms of excess cortisol, growth hormone, and prolactin. They may also order laboratory tests to check their patient’s endocrine function and advise them to seek specialized medical care from an endocrinologist. Some of the tests can include:

• Dexamethasone suppression test
• Urine cortisol test
• Salivary cortisol tests
• Blood tests for hormones such as FSH, IGF-1, LH, Prolactin, Testosterone, TSH
• Visual fields
• MRI

Most patients undergo surgery to remove the tumor, especially if the pituitary tumor is affecting a patient’s vision by pressing against the optic nerves. Surgery is typically done through the transsphenoidal procedure via the nose and sinuses. 

Alternatively, patients who are not physically fit for surgery may undergo radiation therapy to shrink the tumor. Medicine may also be prescribed to shrink applicable tumors. 

Some patients who undergo MRIs for different reasons may accidentally discover a small pituitary tumor. If the tumor is too small to cause hormonal abnormalities or visual symptoms, some medical professionals may follow up with repeat MRI imaging to monitor it. In some cases, these tumors only very slowly grow. 

The outlook is good for most patients who have had their tumor removed. In some rare cases, the tumor can return after surgery, and the surgeon may recommend non-surgical alternatives or a re-operation. 

When left untreated, pituitary tumors can lead to optic nerve damage, which could result in blindness. It could also cause hormonal imbalances, depending on the type of functional pituitary tumor. This could increase the risk of developing conditions such as heart disease, diabetes, and high blood pressure, which could lead to additional complications.

Pituitary tumors can exhibit various symptoms that can be mistaken for other conditions. As a result, some patients may be misdiagnosed or have an undetected tumor until they have undergone extensive tests. If you are experiencing symptoms of a pituitary tumor and would like to seek a second opinion, we recommend scheduling an appointment with Dr. Aaron Cohen-Gadol and his team. 

Aaron Cohen-Gadol, MD, is a globally renowned neurosurgeon. Having performed thousands of complex brain surgeries and mentored hundreds of skilled surgeons, he is determined to deliver the best possible outcomes. As a specialist for pituitary tumors, he and his team can help you understand your condition and your best options moving forward. 

Fill out our online form to schedule a second opinion.  

Learning that pituitary tumors can cause many symptoms related to specific hormones or an enlarged pituitary gland can help patients understand what physiological processes are happening in their body. This can empower patients and decrease anxiety as they move forward with a treatment plan.

• Common pituitary tumor symptoms are headaches, nausea, fatigue, anxiety, vision problems, weight gain, easy bleeding or bruising, menstrual irregularities, lactation, erectile dysfunction, and heat or cold intolerance.
• It is rare that pituitary tumors will directly cause nose pain or pressure.
• Hormones that are often overproduced due to pituitary tumors are prolactin, growth hormone, ACTH and TSH. All of these cause specific symptoms patients can identify.

• Pituitary Network Association 
• National Brain Tumor Society
• American Brain Tumor Association 
• Pediatric Brain Tumor Foundation
• Endocrine Society 
• Pituitary Foundation 
• Cushing’s Support & Research Foundation