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The pituitary gland is a pea-sized gland that sits underneath the base of the brain. It produces and releases many hormones. These hormones control your metabolism, stress level, growth, ovulation and menstruation in women, sperm and testosterone production in men, milk production, and urine production. Because of its many functions, it is often referred to as the “master gland.”
A pituitary adenoma is a common non-cancerous overgrowth (tumor) of the pituitary gland. Some pituitary adenomas cause changes in your hormone levels. Many are very small (microadenomas). Some grow very large (macroadenomas) and may push on the vision pathways. Many people who have pituitary adenomas may not have any symptoms and don’t realize they have one, especially because the vision loss may occur slowly over a long period of time.
Left: Modified from Radiopaedia.org. Case courtesy of Dr. Frank Gaillard. rID: 17529. | Right: Courtesy of Dr. Kevin E. Lai, M.D.
MRI images showing the normal pituitary gland (solid white arrow) and a pituitary tumor (dashed white arrow). The optic chiasm (where the optic nerves meet) is shown by the green arrows and is pushed up by the pituitary tumor.
Left Eye | Right Eye Left Eye | Right Eye
Courtesy of Dr. Kevin E. Lai, M.D.
Peripheral (side) vision loss from a pituitary tumor. These pictures show vision in the left eye on the left and right eye on the right, both from the perspective of the patient. A. Normal visual fields where vision is preserved in both halves of each eye. B. Vision loss from compression by a pituitary tumor. The left half of the vision in the left eye and the right half of the vision in the right eye are dark and not seen.
Because pituitary tumors affect many systems in your body, you may need to have different specialists who will help coordinate the best care for you.
To help measure your vision, your doctor may perform several tests. The visual acuity test measures the sharpness of your central vision (ability to read the eye chart). Color vision can be tested using various plates with figures or numbers on them. A visual field test maps your field of vision. Other tests may also help your doctor look for changes in your optic nerves due to pressure on them from the tumor.
A CT scan or, preferably an MRI scan can help measure the size of the tumor and determine how close it is to your optic nerves, optic chiasm and other parts of your brain.
Not all tumors need to be treated! Small tumors that do not cause any symptoms may be monitored without treatment.
Pituitary tumors are typically benign (non-cancerous) and slow growing. The longer you have vision loss, the less likely your vision will improve with treatment. However, even when there are signs of permanent damage to the optic nerves, there can still be good visual recovery if the pressure on the optic nerves is relieved with medication and/or surgery.
How often your ophthalmologist or neuro-ophthalmologist needs to see you in follow-up will depend on your vision, how quickly it has changed in the past and MRI scan results. Your eye doctor may also examine you before and after any treatments. Once your vision is stable, you and your doctor may choose to extend the duration between your follow-up appointments.
Because pituitary tumors continue to grow slowly, even after a successful surgery, the tumor may come back. To help monitor the tumor, a brain scan (typically an MRI) should be performed on a regular basis. How often you need to be checked is different for everyone and should be discussed with your doctors.
A list is found at the Johns Hopkins Neurology and Neurosurgery Pituitary Tumor page (http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/pituitary_center/patient/support-groups.html).
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This information was developed collaboratively by the Patient Information Committee of the North American Neuro-Ophthalmology Society. This has been written by neuro-ophthalmologists and has been edited, updated, and peer-reviewed by multiple neuro-ophthalmologists. The views expressed in this brochure are of the contributors and not their employers or other organizations. Please note we have made every effort to ensure the content of this is correct at time of publication, but remember that information about the condition and drugs may change. Major revisions are performed on a periodic basis.
This information is produced and made available “as is” without warranty and for informational and educational purposes only and do not constitute, and should not be used as a substitute for, medical advice, diagnosis, or treatment. Patients and other members of the general public should always seek the advice of a physician or other qualified healthcare professional regarding personal health or medical conditions.