Pituitary surgery

What is pituitary surgery?

Pituitary surgery removes a growth in or close to the pituitary gland, a small hormone-producing gland sitting low beneath the brain, tucked behind the eyes. It's most often carried out to protect eyesight or bring hormone levels back under control.

What conditions does pituitary surgery treat?

Growths in the pituitary gland, known as adenomas, are almost always harmless; fewer than 1 in 100 turn out to be cancerous. Surgery tends to be recommended for:

• a growth that's compressing or tugging on the nerves linking the eyes to the brain, affecting eyesight
• a growth driving up hormone levels, as happens with Cushing's disease or acromegaly
• sudden bleeding into the gland, a rare emergency that can affect vision very quickly
• occasionally, a prolactin-producing growth, where medication hasn't worked or isn't suitable.

Plenty of growths turn up by chance and cause no bother whatsoever, in which case keeping watch with regular scans may be suggested instead of an operation.

What are the benefits of pituitary surgery?

Where eyesight's been affected, surgery brings improvement in around 9 out of 10 cases, often noticeable within days or weeks, sometimes continuing to get better for years afterwards. Vision that was already badly affected may not come back completely, though.

For growths churning out excess hormones, the aim is getting levels back to where they should be, which can cut down or even remove the need for long-term medication.

Are there different types of pituitary surgery?

• endoscopic surgery through the nose, the approach used most often, working via a thin camera through a natural passage behind the nose without any cuts to the skin
• microscope-guided surgery through the nose, an older version of the same route, relying on an operating microscope rather than a camera
• surgery through the skull, occasionally needed where a growth proves harder to reach through the nose.

A specialist team, neurosurgeons and endocrinologists (hormone specialists) working together, will talk you through which approach fits your particular growth best.

What happens before pituitary surgery?

Before surgery, expect blood tests, a check of your vision, and scans, usually an MRI. Mentioning any allergies, past health problems and medicines you're on matters, since some, blood thinners like aspirin or warfarin among them, generally need pausing ahead of time to make surgery safer.

You'll be admitted either the night before your operation or that same morning, with clear instructions given on when to stop eating and drinking beforehand.

What happens during pituitary surgery?

1. You're given a general anaesthetic, so you're fully asleep throughout.
2. A thin camera passes through your nostrils, letting your surgeon see the area clearly without needing any cuts to your skin.
3. A small opening is made into the air passage behind the nose to reach the pituitary gland, and as much of the growth as safely possible is removed.
4. The space left behind is packed with material that dissolves naturally over time; nasal packing usually isn't needed.
5. If fluid from around the brain leaks during surgery, a small piece of your own tissue may help seal it, sometimes alongside a temporary drain placed in your lower back for a few days.

Time in theatre generally falls somewhere in the one-to-four-hour range, depending on the size and position of your growth.

What does recovery look like?

You'll spend some time in a recovery area before moving to a specialist ward. Headaches, a stuffy nose and some blood-stained discharge are common for the first couple of days, gradually settling over roughly two weeks.

Blood tests happen daily to check your hormone and fluid levels, and most people are ready to head home somewhere between three and five days on from their operation.

You'll be sent home with hydrocortisone, a steroid medication acting as a safety net while your gland recovers, plus an emergency injection kept on hand just in case. Taking this exactly as prescribed matters enormously, since stopping suddenly without your team's advice can be genuinely dangerous.

• avoid blowing your nose or sneezing forcefully for around 2 to 3 weeks
• hold off on strenuous exercise, swimming and heavy housework for around a month to six weeks
• steer clear of flying for at least six weeks
• don't drive until after your first follow-up check, usually a week after surgery, and tell the DVLA if your eyesight was affected.

Full recovery generally takes 4 to 8 weeks, though this varies quite a bit from person to person.

What are the risks and complications?

Possible risks of pituitary surgery include:

• nasal symptoms such as blockage, crusting, or a reduced sense of smell
• bleeding, infection, or a leak of the fluid surrounding the brain, which may need further treatment
• hormone imbalances, including water balance problems or low steroid levels, sometimes needing long-term hormone replacement
• vision that was already affected beforehand not recovering completely
• rarely, more serious complications such as stroke, damage to a major blood vessel, or loss of vision
• the general risks of a general anaesthetic.

Serious complications are uncommon, affecting fewer than 1 in 1000 people, though less serious complications such as infection or nosebleeds happen more often, affecting around 5 to 10 in every 100.