Symptoms

Many pituitary tumors remain small and do not cause significant symptoms. Symptoms that arise are caused by two mechanisms: hormonal changes caused by the tumor and the growth of the tumor. Pituitary tumors may damage healthy hormone-producing cells, causing a lack of certain hormones and symptoms including fatigue, weakness, growth problems, and disruption of sexual processes. Tumors that produce hormones, known as functioning tumors, often cause symptoms when they are very small (less than 1 cm in diameter). An excess of hormones can cause a wide range of effects that depend on the hormone, such as infertility, abnormal growth, high blood pressure, unusual changes in the skin and body, and specific growth disorders. Larger pituitary tumors (greater than 1 cm) usually are not hormonally active. These nonfunctioning adenomas may protrude outside of the sella turcica and cause symptoms by compressing the surrounding structures. Nonfunctioning adenomas may cause headaches, nausea, vomiting, and, when they push against the optic chiasm, visual deficits.

Diagnosis

As with most brain tumors, imaging studies are essential in the diagnosis of pituitary and parasellar tumors. Imaging techniques for these tumors include magnetic resonance imaging (MRI) and computed tomography (CT) scans, which can be enhanced with the intravenous administration of a contrast agent that distinguishes the tumor from normal tissue.

Treatment

Treatment for a pituitary tumor depends on its hormonal activity and whether it affects surrounding tissue. Both functional and nonfunctional tumors may be treated with surgery sometimes followed by radiation therapy. In addition, drug therapy has shown some effectiveness in certain functional adenomas. Because of their location, these tumors often can be difficult to reach surgically. The development of a particular surgical approach, known as transsphenoidal hypophysectomy, has made surgical treatment of pituitary adenomas safer and more effective. In addition, some smaller pituitary tumors may be treated effectively with stereotactic radiosurgery, which involves the use of a highly focused beam of radiation to target the tumor cells specifically and leave the surrounding brain unaffected.

Causes

It is not clear how these tumors occur, but they are thought to arise from leftover cells from a developmental structure called the Rathke pouch.

Symptoms

Symptoms of craniopharyngiomas are caused by the compression of adjacent structures as the tumor grows. The tumors usually are located near critical structures, including the pituitary gland, hypothalamus, optic nerves, and important arteries. If the tumor compresses the stalk of the pituitary gland or involves the gland itself, for example, it may result in pituitary hormone deficiency that contributes to retarded growth, obesity, and a range of other hormonal problems. Similarly, visual deficits may result if the tumor affects the visual pathways or nerves. Large tumors also will block the flow of cerebrospinal fluid, which bathes the brain and spinal cord, resulting in hydrocephalus, an increase in pressure within the brain that causes headache, nausea, and vomiting.

Diagnosis

Imaging studies are the key component in the diagnosis of craniopharyngiomas. A contrast agent is administered intravenously so neurosurgeons can visualize the tumor against the normal brain in the background.

• Magnetic resonance imaging (MRI) scans are important to help determine the relationship of the tumor to the adjacent structures.
• Computed tomography (CT) scans also are used.
• In some cases, neurological surgeons may employ an MRI scan with frameless stereotactic guidance. For this study, a contrast MRI is performed after special markers (called fiducials) are placed on the child’s scalp. The fiducials are processed by a computer, which calculates the location of the tumor and creates a three-dimensional reconstruction. This image then is used at the time of surgery to help locate the tumor precisely, maximize tumor removal, and minimize injury to the surrounding brain.
• In children with craniopharyngiomas, ophthalmologic and endocrine evaluations also are conducted.

Treatment

The initial treatment for a craniopharyngioma usually is surgery to remove as much of the tumor as possible while preserving pituitary and neural function. Unfortunately, because these tumors tend to adhere to nearby structures, neurosurgeons sometimes must make a choice between a total resection, which carries the risk of significant neurological and endocrine problems, and an incomplete resection, which does little to stop the tumor from recurring. And even in cases of total resection, these tumors tend to return, so repeat MRI or CT scans are conducted for a period of time following initial treatment. Also, long-term hormone replacement therapy may be necessary after surgery.

Radiation therapy is used as a follow-up to surgery, especially in cases of less than total resection, but may have adverse effects on the development of young children. In addition, some tumors may be treated effectively with stereotactic radiosurgery, which involves the use of a highly focused beam of radiation to target the cancer cells specifically and leave the surrounding brain unaffected.

Dr. D’Ambrosio’s practice is devoted to brain tumors, skull base tumors, meningiomas, acoustic neuromas, pituitary tumors, microvascular decompression for trigeminal neuralgia and hemifacial spasm, cerebral aneurysm treatment, degenerative spine disease, and intervertebral disc disease.

He uses state-of-the-art technology such as frameless image guidance systems, awake craniotomy, and stereotactic radiosurgery (i.e. GammaKnife, BrainLab, Tomotherapy) for the treatment of primary and metastatic brain tumors.  He has particular expertise in the use of endoscopic techniques to remove complex intracranial tumors at the base of the brain.

Dr. D’Ambrosio directs our Northern New Jersey practice based in Ridgewood, NJ.  He is the Director of Neuro-Oncology – Disease Management Team at the Luckow Cancer Center of The Valley Hospital in Ridgewood, NJ.  Dr. D’Ambrosio is also the Director of Neurosciences for the St. Joseph’s Healthcare System in Paterson and Wayne, NJ.  He sees patients at The Valley Hospital, St. Joseph’s Regional Medical Center, St. Joseph’s Wayne Hospital, Chilton Memorial Hospital, and Mountainside Hospital.  With his main office in Ridgewood, New Jersey, Dr. D’Ambrosio has helped to establish a center of excellence for Columbia Neurosurgery in the communities of Bergen, Passiac and Essex counties.

As Co-Director of the Brain Tumor Center, Dr. Bruce leads an NIH-funded translational brain tumor research effort with interests in immunotherapy and drug delivery systems. In addition to his laboratory research interests, he is actively involved in experimental clinical protocols for the treatment of brain tumors.

Dr. Bruce’s special interests include Brain Tumors, Skull Base Tumors, Pituitary Tumors and Gamma Knife Radiosurgery.

Learn more here: They Walk in the Shoes of Giants and Even Sit in Their Chairs

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