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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Endocrinology · Pituitary Adenoma

Recognizing the Signs of a Pituitary Tumor

At a Glance

Pituitary tumors can cause symptoms by making extra hormones or pressing on nearby brain and eye structures. Warning signs include unusual growth, enlarged hands or jaw, menstrual or sexual changes, headaches, and vision loss; sudden severe symptoms need emergency care.

Symptoms of a pituitary tumor are generally caused by two factors: the hormones the tumor produces and the physical pressure it puts on surrounding brain structures [1][2]. Because AIP-mutated tumors often grow larger and faster than non-genetic (sporadic) tumors, and typically appear at a younger age (childhood, teens, or 20s), monitoring for these signs is crucial [3][4].

Keep in mind that many common issues—like headaches, fatigue, or menstrual irregularities—often have causes entirely unrelated to a pituitary tumor. However, severe or sudden new symptoms always warrant medical evaluation.

Excess Growth Hormone: Gigantism vs. Acromegaly

About 79% of AIP-mutated tumors produce excess Growth Hormone (GH) [1]. The symptoms depend entirely on when the tumor starts growing in relation to your bone development.

  • Pituitary Gigantism: If the tumor develops in childhood or adolescence before the epiphyseal plates (growth plates) in the bones have fused, it leads to rapid and excessive linear growth [5][6]. A child might be significantly taller than their peers or parents, or experience a growth spurt that feels out of proportion [7][8].
  • Acromegaly: If the tumor starts after the growth plates have fused (which usually occurs during adolescence), the bones can no longer grow longer, so they grow wider [5]. This causes a slow change in appearance, such as a more prominent jaw (prognathism), a wider nose, or larger hands and feet [9][10]. You might notice your rings no longer fit or your shoe size is increasing [9].

Prolactin-Producing Tumors (Prolactinomas)

Some AIP tumors produce prolactin, the hormone responsible for milk production. Excess prolactin can disrupt the balance of sex hormones [2][11].

  • In Women: Symptoms often include irregular periods or periods that stop entirely (amenorrhea), and unexpected breast milk production (galactorrhea) [11].
  • In Men: Symptoms are often more subtle, including a decreased interest in sex (libido), erectile dysfunction, or low energy levels due to decreased testosterone [12].

Symptoms of Large Tumors (Macroadenomas)

A macroadenoma is a tumor larger than 1 centimeter [4]. Because the pituitary gland sits in a small space called the sella turcica, a growing tumor puts pressure on the structures around it.

  • Vision Changes: If the tumor grows upward (suprasellar extension), it can press on the optic chiasm, the place where the optic nerves from your eyes cross [1][13]. This often causes a “tunnel vision” effect, where you lose your side (peripheral) vision [14].
  • Double Vision: If the tumor grows sideways into the cavernous sinus, it can press on nerves that control eye movement, causing double vision or a drooping eyelid [12][14].
  • Headaches: Persistent, deep headaches are common as the tumor puts pressure on the surrounding membranes [1][15].

RED FLAG: Pituitary Apoplexy

Pituitary apoplexy is a rare but life-threatening emergency where a tumor suddenly bleeds or loses its blood supply [16]. It is more common in larger or invasive macroadenomas in general, which include many of the tumors seen in AIP families [1]. Apoplexy can also induce an acute drop in cortisol, triggering life-threatening adrenal insufficiency.

Seek emergency medical care immediately if you experience:

  • A sudden, “thunderclap” headache (the worst headache of your life) [16][17].
  • Sudden loss of vision or double vision [16].
  • Nausea and violent vomiting [18].
  • Symptoms of acute adrenal insufficiency: confusion, extreme weakness, or fainting [18][19].

Early treatment of apoplexy is vital to protect your vision and stabilize your hormone levels [18][20].

Common questions in this guide

What symptoms can a pituitary adenoma cause?
Symptoms depend on whether the tumor makes extra hormones and how large it becomes. Possible signs include unusual growth, changes in the hands, feet, or facial features, menstrual or sexual changes, headaches, and vision problems.
How are pituitary gigantism and acromegaly different?
Excess growth hormone causes pituitary gigantism when a tumor develops before the bones' growth plates have fused, leading to rapid height gain. When the growth plates have fused, the bones grow wider instead, causing acromegaly features such as a larger jaw, hands, or feet.
What are the signs of a prolactinoma?
A prolactin-producing pituitary tumor can disrupt sex hormones. It may cause irregular or absent periods and unexpected breast milk in women, or reduced sex drive, erectile dysfunction, and low energy in men.
Can a large pituitary tumor affect vision?
Yes. A large tumor can press on the point where the optic nerves cross and cause loss of side vision, or it can affect eye-movement nerves and cause double vision or a drooping eyelid.
When should I seek emergency care for pituitary tumor symptoms?
Seek emergency care for a sudden worst-ever headache, sudden vision loss or double vision, violent vomiting, confusion, extreme weakness, or fainting. These symptoms can signal pituitary apoplexy, a sudden bleed or loss of blood supply to the tumor that may also cause a dangerous drop in cortisol.
Do headaches or fatigue always mean I have a pituitary tumor?
No. Headaches, fatigue, and menstrual changes are common and often have causes unrelated to a pituitary tumor. New, severe, sudden, or worsening symptoms still deserve medical evaluation.

Questions For You

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Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given my age and family history, how large is my tumor, and does it show signs of 'suprasellar extension' (upward growth) or cavernous sinus invasion?
  2. 2.Are my growth hormone and IGF-1 levels high enough to suggest gigantism or acromegaly, and how does this affect my long-term health?
  3. 3.If I have a prolactinoma, what are the chances it will respond well to medication versus needing surgery?
  4. 4.Is my vision being affected by the tumor, even if I haven't noticed changes myself? Should I see a neuro-ophthalmologist?
  5. 5.What are the specific signs of pituitary apoplexy or adrenal insufficiency I should watch for that would require an immediate ER visit?

References

References (20)
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    Significant Benefits of AIP Testing and Clinical Screening in Familial Isolated and Young-onset Pituitary Tumors.

    Marques P, Caimari F, Hernández-Ramírez LC, et al.

    The Journal of clinical endocrinology and metabolism 2020; (105(6)) doi:10.1210/clinem/dgaa040.

    PMID: 31996917
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    Pituitary Disease in AIP Mutation-Positive Familial Isolated Pituitary Adenoma (FIPA): A Kindred-Based Overview.

    Bilbao Garay I, Daly AF, Egaña Zunzunegi N, Beckers A

    Journal of clinical medicine 2020; (9(6)) doi:10.3390/jcm9062003.

    PMID: 32604740
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    HEREDITARY ENDOCRINE TUMOURS: CURRENT STATE-OF-THE-ART AND RESEARCH OPPORTUNITIES: The roles of AIP and GPR101 in familial isolated pituitary adenomas (FIPA).

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    Clinical Relevance of Genetic Analysis in Patients With Pituitary Adenomas: A Systematic Review.

    van den Broek MFM, van Nesselrooij BPM, Verrijn Stuart AA, et al.

    Frontiers in endocrinology 2019; (10()):837 doi:10.3389/fendo.2019.00837.

    PMID: 31920960
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    An Update on Pituitary Neuroendocrine Tumors Leading to Acromegaly and Gigantism.

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    PMID: 34067494
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    Pituitary adenoma presenting as acute onset isolated complete third cranial nerve palsy without vision changes.

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    A pediatric case of pituitary macroadenoma presenting with pituitary apoplexy and cranial nerve involvement: case report.

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This page is for informational purposes only and does not constitute medical advice. It explains possible pituitary adenoma symptoms, but your clinician must interpret your symptoms and tests; seek emergency care for sudden severe headache, vision changes, confusion, or fainting.