Sudden severe headache with visual loss, double vision or collapse needs emergency care now. This may be pituitary apoplexy — bleeding into the tumour — which requires urgent steroid treatment and sometimes urgent surgery.
Tumours of the small gland beneath the brain that controls the body's hormone system. Almost all are benign, and the treatment depends far more on which hormone they produce than on their size.
One type of pituitary tumour is treated with tablets and shrinks without any operation. Being offered surgery for it is a common and entirely avoidable error, which is why the hormone tests come before anything else.
The pituitary sits in a bony hollow at the base of the skull, directly beneath the crossing point of the optic nerves. It controls the thyroid, the adrenal glands, growth, reproduction and water balance. Its position explains both sets of symptoms these tumours cause: hormonal disturbance from the gland itself, and visual loss from pressure on the optic nerves above.
Tumours are divided by whether they produce hormone. A prolactinoma produces prolactin, causing milk production, absent periods and infertility in women, and low testosterone and erectile problems in men. Growth hormone excess causes acromegaly — enlarging hands, feet and jaw, with diabetes and heart problems. ACTH excess causes Cushing's disease. Non-functioning tumours produce nothing and present only when large enough to press on the optic nerves.
The distinction matters enormously because prolactinomas respond to tablets. Dopamine agonist medication shrinks them, often dramatically, and normalises prolactin in the large majority of patients. Operating on a prolactinoma that would have responded to medication is one of the clearest avoidable errors in this area.
Because the tumour sits directly below the optic chiasm, the classic visual defect is loss of the outer half of the field in each eye. Patients frequently do not notice it until they bump into things or fail a driving test.
Prolactin, growth hormone with IGF-1, cortisol, thyroid function, testosterone or oestrogen, and the other pituitary hormones should all be measured before any surgical decision. A prolactinoma is treated with tablets and often shrinks substantially without surgery, and it is not rare for patients to be offered an operation for one. If a pituitary tumour has been found on a scan and surgery proposed without a full hormone profile, that is the point to pause and ask.
Blood tests and a dedicated MRI, together, answer nearly everything.
A pituitary MRI without hormone results tells us very little about what should be done. The prolactin level in particular changes the entire plan — a markedly raised level in a patient with a large tumour usually means medication rather than surgery. Send every hormone result you have, with the units and reference ranges, alongside the imaging.
Which treatment is right depends almost entirely on which hormone the tumour produces.
Dopamine agonist tablets normalise prolactin and shrink the tumour in the large majority of patients, frequently restoring vision and fertility without any operation. Surgery is reserved for those who cannot tolerate the medication, do not respond to it, or present with apoplexy.
The tumour is reached through the nostril and the sphenoid sinus with an endoscope, with no opening of the skull and no visible scar. It is the standard approach for non-functioning tumours compressing the optic nerves, for growth hormone and ACTH-producing tumours, and for prolactinomas not responding to medication. Best results come from a neurosurgeon and ENT surgeon operating together.
Where surgery does not achieve remission, somatostatin analogues and growth hormone receptor blockers control acromegaly, and several drugs control cortisol excess in Cushing's disease. These are usually additional to surgery rather than instead of it.
Focused radiation controls residual or recurrent tumour, with the effect developing over months to years. Separately, many patients need replacement of hormones the gland can no longer produce — thyroid, steroid, and sometimes growth or sex hormones — and this replacement is lifelong and needs proper supervision.
Prolactin means tablets. Growth hormone and ACTH mean surgery. Non-functioning means surgery only if vision is threatened or the tumour is growing.
Compression of the optic chiasm makes surgery urgent, because visual recovery is much better when decompression is early.
Whether the tumour extends sideways into the cavernous sinus determines how completely it can be removed and whether radiation will be needed afterwards.
If your prolactin is high and the picture fits a prolactinoma, we will recommend medication and a repeat scan — not an operation.
Pituitary apoplexy and rapidly failing vision are emergencies. Both need steroids and assessment locally the same day.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
A prolactinoma usually can. Dopamine agonist tablets normalise the hormone and shrink the tumour in most patients, often restoring vision and fertility without any operation. Other types generally need surgery, though medication has a role where surgery does not achieve full control.
No. Endoscopic transsphenoidal surgery is performed through the nostril, so there is no skin incision and no visible scar. Most patients are in hospital for three to five days and the recovery is markedly quicker than after any operation that opens the skull.
Frequently yes, and often quite quickly after the pressure on the optic nerves is relieved, though recovery is better the earlier decompression happens. Long-standing severe visual loss recovers less completely. This is why deteriorating vision moves a pituitary tumour up the urgency list.
Some patients do. Where the tumour or the surgery has damaged the normal gland, replacement of thyroid hormone, steroid and sometimes sex or growth hormone is needed indefinitely. Steroid replacement in particular must never be stopped abruptly and needs increasing during illness — you should be given written instructions about this.
Old photographs are the most useful test you can do yourself. Compare your face now with pictures from ten and twenty years ago, and check whether rings and shoes still fit. The changes are slow enough that people close to you rarely notice. Bring the photographs — they are genuinely diagnostic, alongside an IGF-1 blood test.
Often yes, and fertility is a common reason people seek treatment. Prolactinomas frequently cause infertility that resolves once the prolactin is normalised with tablets. Where the gland is deficient after treatment, hormone replacement can restore fertility in many patients. Tell us if this matters to you — it shapes the plan.
Send the pituitary MRI together with your full hormone profile. The prolactin level alone frequently determines whether you need surgery at all.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.