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Pituitary Tumors

WUSTL Neurosurgeons
Pituitary Center Team: (from left) Gregory Zipfel, MD; Albert Kim, MD, PhD; Julie Silverstein, MD; Ralph Dacey, Jr., MD; Michael Chicoine, MD; and Keith Rich, MD

Washington University neurosurgeons are recognized as leaders in the region for the treatment of pituitary tumors. We have a dedicated Washington University Pituitary Center under the direction of neurosurgeon Albert H. Kim, MD, PhD, and endocrinologist Julie Silverstein, MD, which provides multidisciplinary and comprehensive evaluation and treatment for a variety of pituitary disorders and conditions such as:

  • Acromegaly
  • Craniopharyngiomas
  • Cushing's disease
  • Diabetes insipidus
  • Hypopituitarism and other hypothalamic tumors
  • Hyperprolactinemia
  • Non-functioning pituitary tumors
  • Parasellar meningiomas
  • Pituitary cysts
  • Prolactinomas
  • Recurrent pituitary tumors
  • TSH-secreting pituitary tumors

Patients referred to the Pituitary Center received collaborative care from both neurosurgeons and a specialized endocrinologist with expertise in pituitary disorders.

Learn more about the Washington University Pituitary Center:


Pituitary Tumors

Pituitary tumors are abnormal growths found in the pituitary gland, which is located at the base of the brain. These tumors are among the most common brain tumors and are almost always benign. Their growth can compress nearby cranial nerves, causing blind spots, blurred vision, or double vision.

Pituitary tumors also can cause symptoms through the overproduction of hormones. The pituitary gland is a master gland that secretes many hormones that travel throughout the body, such as

  • Growth hormone (GH), also called somatotropin
  • Prolactin, which helps to stimulate lactation
  • Adrenocorticotropin (ACTH), which stimulates the production of cortisol (a hormone active in metabolism)
  • Follicle-stimulating hormone (FSH) and lutenizing hormone (both reproduction-related hormones)
  • Thyroid-stimulating hormone (TSH), or thyrotropin

Overproduction of hormones by the tumor leads to a variety of symptoms, depending on the hormone involved:

  • Prolactin-producing pituitary tumors are the most common hormone-producing pituitary tumors. In women, these tumors cause decreased libido, infertility, altered menses, and milk discharge from their breasts. In men, these tumors induce impotence and decreased libido.
  • Cushing’s disease occurs when the hormone ACTH is overproduced, causing a high level of cortisol. Patients with Cushing’s disease experience symptoms such as weight gain (especially upper body obesity, a round face, and increased fat around the neck); easy bruising; purple or pink stretch marks over the abdomen, thighs, buttocks, arms and breasts; and weak bones that are prone to fracture. Women develop excessive hair growth on face, neck, chest, abdomen and thighs, and have irregular menses. Men develop decreased fertility and/or libido. Other signs and symptoms include severe fatigue, weak muscles, high blood pressure, high blood glucose, increased thirst and urination, irritability, anxiety and depression.
  • Growth hormone-producing pituitary tumors cause patients to develop coarsening of their facial features, enlargement of the hands and feet, and other symptoms.
  • TSH-producing pituitary tumors cause patients to develop rapid heart rate, tremors, unexplained weight loss, increased appetite, anxiety, frequent bowel movements, and a lump in the front of the neck (due to an enlarged thyroid gland).

Treatment Options

Neurosurgeons and specialists in the Washington University Pituitary Center provide a full range of treatment, including surgical tumor removal and Gamma Knife radiosurgery. The team uses an advanced intraoperative MRI system that provides precise imaging of the tumor(s) and maximizes the extent of safe tumor removal.

Pituitary tumors that are large and cause compressive symptoms may require treatment with surgery. Medical therapies may be available for hormone-producing tumors such as prolactin-producing tumors. In certain cases, Gamma Knife radiosurgery or radiation therapy may be appropriate.

Craniopharyngiomas

Craniopharyngiomas are benign tumors that arise from portions of the pituitary gland or stalk. These tumors typically are partially cystic and partially calcified and cause symptoms either by decreasing pituitary hormone production or compressing the optic nerves, leading to visual decline. Craniopharyngiomas commonly occur in children, but can grow and cause problems in adults. They tend to grow slowly (over months to years), but their location can make treatment difficult.

For many craniopharyngiomas, the most common treatment is surgical removal. Surgery previously was performed exclusively through an open craniotomy, requiring an incision of the scalp and removal of part of the skull. However, many craniopharyngiomas may now be removed through an endoscopic endonasal approach. Gamma Knife radiosurgery or fractionated radiotherapy may be possible options in select cases.

Rathke's Cleft Cysts

Rathke's cleft cysts are benign, fluid-filled cysts. While they sometimes have minimal symptoms, they can grow over time, causing compression of the optic nerve and leading to decreased vision or to double vision because of additional pressure on other cranial nerves.

Generally, surgical drainage or removal is the treatment of choice for Rathke's cleft cysts. In the past, these cysts were treated with a transsphenoidal approach that uses an incision below the lip or in front of the nose. Now, a minimally invasive, endoscopic endonasal approach allows for excellent treatment without the need for these incisions.

Read more about the endoscopic endonasal procedure

Pituitary Tumor Conferences

The multidisciplinary Pituitary Conference is held on the third Tuesday of every month during the academic year. Physicians from neurosurgery, endocrinology, radiation oncology, medical oncology, and ophthalmology review cases to improve the diagnosis and management of pituitary lesions.

Physicians wishing to submit cases for review should contact the Pituitary Tumor Board Coordinator at (314) 747-6141.

Faculty

Pituitary Center Co-Directors

Neurosurgery Providers

Otolaryngology Providers

  • Richard A. Chole, MD, PhD
  • Jonathan L. McJunkin, MD
  • Ravindra Uppaluri, MD, PhD
  • Bruce H. Haughey, MBChB, MS, FACS, FRACS

Medical Oncology Providers

  • David D. Tran, MD, PhD

Opthalmology

  • Collin M. McClelland, MD
  • Gregory Van Stavern, MD

Patient Office Locations

Adult Patients
WUSTL Office Location
Neuroscience Center
Center for Advanced Medicine
4921 Parkview Place, Suite 6C
St. Louis, Missouri 63110


WUSTL Office Location
Barnes-Jewish West County Office
1040 North Mason Road, Suite 211
Creve Coeur, Missouri 63141

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