NON FUNCTIONING PITUITARY ADENOMA

What is NFPT?

It is a type of the pituitary tumour which does not produce any hormones.

Although this tumour does not produce any hormone, it can cause pressure on the normal pituitary, which can disturb normal hormone production. It can also cause pressure on the surrounding structures, which can cause headaches and impaired vision.

It is a small pea size gland situated in a hollow bony pouch, at the base of the brain, at the back of the bridge of the nose. It is the master gland of the endocrine system and controls the functions of the other endocrine glands.

Effects on the surrounding structure can cause impaired vision and headache. Pressure on the normal pituitary gland can cause under production of the normal pituitary hormones, which can have different effects on your body depending on the types of the hormones involved. Pressure on the neck of the pituitary gland can cause over production of the prolactin with subsequent effects on your body.

The pituitary produces TSH which circulates to the thyroid stimulating this gland in your neck to make and release thyroid hormones called Thyroxine and Tri-iodothyronine

This hormone stimulate the adrenal glands (small endocrine glands situated on the top of your kidneys) to produce cortisol. This is a steroid hormone which is essential for the everyday activities and health. Lack of cortisol causes severe fatigue and lack of appetite with weight loss.

This has effects on the various tissue of the body. In children, it is essential to reach the normal growth. In adult, it appears to maintain normal energy levels and to keep body tissue such a muscle and bones strong and healthy.

These include Follicular Stimulating Hormone (FSH) and Luteinising Hormone (LH).These hormones have effects on the ovaries, uterus, and on the testes in man. These hormones regulate and control the male and female hormones, menstrual cycles, ovulation, sperm production and fertility.

This hormone stimulates the breasts and regulates milk production. It is normally produced in very high levels during the pregnancy and breast- feeding. This hormone can be responsible for irregular or absent menstrual periods and the lack of libido.

This hormone circulates to the kidneys where it regulates the amount of urine produced. Too little ADH causes continual thirst and copious output of urine day and night.

What tests will be required for NFPA?

• Blood tests to check the level of the hormones which are controlled by the pituitary
• You may need a special test called COMPLETE PITUITARY FUNCTION TEST This test measures the pituitary hormones before and after stimulation to see if the normal pituitary is adequately working.
• Vision field check.The optic nerve which relays images from your eye to your brain passes very close to the pituitary gland. Tumours of the pituitary gland can expand causing pressure on this nerve and this will cause impaired vision initially involving the periphery of the vision. This is checked by a special computerised light screen. Dots of light appear on the screen and the patient has to identify when they are seen.
• Special scans such as MRI (or CT) can detect the site and extent of the tumour and also of degree of invasion and pressure on the surrounding structures.

This will require an operation to remove the tumour as there is no medical therapy at present which will shrink the tumour. The operation is usually performed up your nose (called Transsphenoidal Hypophysectomy) or if the tumour is too large for this approach then it may have to be removed by an open head surgical approach called a craniotomy. Although the surgeon will try to save the normal pituitary tissue this might not be possible. This depends on the extent of invasion and the size of the tumour. If total removal is impossible, you may require follow on Radiotherapy to treat the remaining tumour cells.

You will require regular follow-up by a specialist.

• Blood tests to recheck the levels of the hormones controlled by the pituitary with repeat COMPLETE PITUITARY FUNCTION TEST
• Repeat visual field charting
• Repeated MRI scans to reassess the pituitary and the surrounding structures.

If it was impossible to save the normal pituitary during the surgery then you are likely to become HYPOPITUITARY and will require PITUITARY REPLACEMENT THERAPY. Even if you do not require all hormones replaced initially often radiotherapy will in time require this as radiotherapy in treating the tumour also damages the normal pituitary tissues.

Why not contact the Pituitary Foundation at;

PO Box 1944
Bristol, BS99 2UB.
Tel/Fax 0117 927 3355
e-mail- helpline@pitpat.demon.co.uk

or try the website: http://www.pituitary.com/
or www.pituitary.org.uk

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Ó NHS Tayside; 2006; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.