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Health condition

Pituitary tumours, usually benign, often found by chance - and treatable when they matter.

A pituitary adenoma can press on vision, upset hormones or simply sit quietly. Knowing its size and whether it is making hormone decides whether to watch, treat with medicine, operate or irradiate.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against Society for Endocrinology and Endocrine Society guidance and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice, including cabergoline for prolactinoma, endoscopic surgery and the emergency management of apoplexy.

Key facts

Pituitary tumours at a glance.

The essentials, in plain English - what they are, how they differ, and how they are approached in the UK today.

  • What it is

    A growth in the pituitary gland, almost always a benign adenoma. It can press on nearby structures or make too much of a hormone.

  • Usually benign

    Pituitary adenomas do not behave like cancer and rarely spread. Pituitary carcinoma is exceptionally rare.

  • Size

    Microadenomas are under 10 mm. Macroadenomas are 10 mm or larger and are more likely to affect vision and normal pituitary function.

  • Functioning or not

    Functioning tumours over-produce a hormone - prolactin (prolactinoma), growth hormone (acromegaly), ACTH (Cushing disease) or, rarely, TSH. Non-functioning tumours do not.

  • Often found by chance

    Many small tumours are spotted on a scan done for something else (an incidentaloma) and never cause a problem.

  • Team-based care

    Best managed by a pituitary multidisciplinary team: endocrinology, neurosurgery, neuro-ophthalmology, neuroradiology and oncology.

Why this guide matters

Size, hormones and vision decide the plan.

A diagnosis of pituitary tumour sounds alarming, yet the outlook is usually good. The three points below shape everything else on this page.

  • Not every tumour needs treatment

    Small incidental adenomas with normal hormones and normal vision are often simply monitored. Treating them unnecessarily adds risk without benefit.

  • Vision and hormones are the priorities

    The goals are to protect sight, control any hormone excess and preserve or replace normal pituitary function. Formal visual fields matter as much as the scan.

  • A specialist team improves outcomes

    Pituitary tumours are best managed by an endocrinologist working with a pituitary neurosurgeon, neuro-ophthalmologist and oncologist, ideally in a dedicated MDT.

How the diagnosis is made

From a first finding to a clear plan.

The steps a UK GP or endocrinologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and examination

    Headache, vision, periods, sexual function, energy, growth of hands or feet, medicines that raise prolactin and family history all matter.

  2. 02

    Assessing

    Pituitary hormone panel

    Prolactin, IGF-1, morning cortisol, thyroid tests (TSH and free T4), LH, FSH, oestradiol or testosterone, and sodium.

  3. 03

    Assessing

    Dedicated pituitary MRI

    Contrast-enhanced MRI shows size, position and any contact with the optic chiasm or cavernous sinus.

  4. 04

    Confirming

    Formal visual field testing

    Perimetry, acuity and colour vision are checked whenever a tumour is near the optic chiasm, to pick up bitemporal field loss.

  5. 05

    Confirming

    Dynamic tests when needed

    A glucose tolerance test for growth hormone, dexamethasone suppression for Cushing disease, or cortisol reserve testing.

  6. 06

    Planning

    MDT discussion

    Results are reviewed together by the pituitary team, who agree whether to observe, treat medically, operate or irradiate.

  7. 07

    Planning

    Plan and baseline follow-up

    A written plan sets out treatment, replacement hormones if needed, and the schedule for repeat MRI, bloods and vision checks.

Typical timeline: from first blood tests to an MDT plan in a few weeks, faster if vision is threatened.

Symptoms

What a pituitary tumour can cause.

Symptoms come from pressure on nearby structures, from hormone excess or from hormone deficiency - or from none of these. And the sudden pattern that means an emergency.

  • Headache

    Often a dull, persistent headache from the tumour stretching the covering of the gland. Not everyone has one.

  • Loss of side vision

    Pressure on the optic chiasm classically removes the outer half of vision in both eyes (bitemporal hemianopia).

  • Underactive pituitary

    Tiredness, feeling cold, low mood, low appetite, low libido or dizziness when standing can signal hormone deficiency.

  • Prolactin excess

    Absent or irregular periods and milky nipple discharge in women; low libido, erectile problems or infertility in men.

  • Growth hormone excess

    Enlarging hands, feet and jaw, coarser features, sweating, snoring and joint aches - the pattern of acromegaly.

  • Cortisol excess

    Weight gain around the trunk, purple stretch marks, easy bruising, muscle weakness, high blood pressure or diabetes.

  • No symptoms at all

    A small tumour found incidentally on a scan, with normal hormones and normal vision, is very common.

  • Red flag - sudden severe headache

    Abrupt, severe headache with visual loss or double vision may be pituitary apoplexy and needs emergency care.

Treatment

How pituitary tumours are managed in the UK.

Observation for small incidental tumours, cabergoline for prolactinoma, surgery where vision or hormone excess demands it - with radiotherapy, replacement therapy and lifelong follow-up as needed.

  • Watchful waiting

    Suitable for small tumours with normal hormones and no threat to vision. Repeat blood tests and MRI at agreed intervals.

  • Cabergoline for prolactinoma

    First-line treatment. A dopamine agonist that usually lowers prolactin and shrinks the tumour. Side effects include nausea and dizziness.

  • Transsphenoidal surgery

    Usually endoscopic, through the nose with no external incision. Often first choice for non-functioning tumours affecting vision, acromegaly and Cushing disease.

  • Somatostatin analogues, pegvisomant

    For acromegaly when surgery is not curative or suitable. Octreotide or lanreotide reduce growth hormone; pegvisomant blocks its action.

  • Medicines for Cushing disease

    Cortisol-lowering drugs such as metyrapone or osilodrostat, or pasireotide, can control cortisol around surgery or radiotherapy.

  • Radiotherapy or radiosurgery

    Stereotactic radiosurgery or fractionated radiotherapy for residual or recurrent tumour. Effects build slowly over years.

  • Hormone replacement

    Hydrocortisone, levothyroxine and sex hormones, sometimes growth hormone or desmopressin, replace what the pituitary can no longer supply.

  • Long-term MDT follow-up

    Scheduled MRI, hormone tests and vision checks to catch regrowth or new deficiency early, often lifelong.

What this guide is based on

The sources behind every claim on this page.

UK specialist society guidance and international endocrine standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your endocrinologist or GP knows your history and results and can tell you which parts apply to you. If in doubt, get seen.

  • Society for Endocrinology. UK guidelines for the management of pituitary apoplexy (Rajasekaran et al., Clinical Endocrinology, 2011).

  • Society for Endocrinology. Endocrine emergency guidance: emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients.

  • Endocrine Society. Clinical practice guidelines on hyperprolactinaemia, acromegaly and pituitary incidentaloma.

  • The Pituitary Foundation. Patient information on pituitary tumours and hormone replacement.

Red flags

When a pituitary tumour needs urgent attention.

Most pituitary tumours are managed calmly over months. These are the situations that are not - apoplexy and adrenal crisis are emergencies.

  • Pituitary apoplexy

    Sudden severe headache with visual loss, double vision, drooping eyelid, vomiting or drowsiness. Call 999 or attend A&E - urgent hydrocortisone and specialist review are needed.

  • Adrenal crisis

    Collapse, vomiting, severe weakness, low blood pressure or confusion in someone with cortisol deficiency. Needs emergency injected hydrocortisone - call 999.

  • Rapidly worsening vision

    New or progressive loss of side vision, blurring or colour dulling suggests chiasm compression and needs urgent same-day assessment.

  • Double vision or drooping eyelid

    Can mean pressure on the nerves beside the pituitary in the cavernous sinus - urgent assessment is needed.

  • Extreme thirst and passing lots of urine

    May indicate diabetes insipidus, most often after surgery. Needs prompt blood and urine tests and possibly desmopressin.

  • Clear fluid from the nose after surgery

    A watery drip can be a cerebrospinal fluid leak. With headache, fever or neck stiffness, contact the surgical team urgently.

  • Confusion or nausea after surgery

    Low sodium can develop several days after pituitary surgery, often in the first two weeks. Report it to the team at once.

  • Unwell on steroid replacement

    During illness, injury or vomiting, hydrocortisone needs increasing under sick-day rules. If tablets cannot be kept down, an injection is essential.

  • Pregnancy with a known prolactinoma

    Larger tumours can enlarge in pregnancy. New headaches or vision changes need urgent review, and planning ahead is best.

Living with it

A long-term condition, well managed together.

Four things that make the biggest difference - taking replacement hormones reliably, keeping follow-up, planning a family early and looking after energy and mood.

A quiet reminder

Steady follow-up catches problems early.

Most people with a treated pituitary tumour lead full lives. Regular checks, not worry, are what protect that.

  1. 01 Medication

    Never miss replacement therapy

    Carry a steroid emergency card and consider a medical alert bracelet. Know your sick-day rules and keep spare injection kits in date.

  2. 02 Monitoring

    Keep follow-up appointments

    Repeat MRI, hormone tests and visual fields are how regrowth or new deficiency is caught early - even when you feel well.

  3. 03 Fertility

    Plan a family with your team

    Fertility often recovers once prolactin or cortisol is controlled. Talk to the team before trying to conceive so medicines can be adjusted.

  4. 04 Everyday

    Fatigue, mood and driving

    Tiredness and low mood are common and treatable. If your visual fields are affected you may need to tell the DVLA - your specialist will advise.

Frequently asked

Everything we get asked about pituitary tumours.

Quick answers on cancer risk, treatment choices, hormone replacement and apoplexy.

  • Is a pituitary tumour cancer?

    Almost never. Most pituitary tumours are benign adenomas that grow slowly and do not spread. They can still cause problems by pressing on nearby structures or by making too much of a hormone, which is why they are followed up carefully. Pituitary carcinoma is exceptionally rare.

  • Do all pituitary tumours need treatment?

    No. A small tumour found incidentally, with normal hormone tests and normal vision, can often be watched with a limited period of repeat imaging. Larger tumours, those affecting vision and those making excess hormone are more likely to need treatment.

  • How is a prolactinoma treated?

    Cabergoline is the first-line treatment. It usually brings prolactin back to normal and shrinks the tumour. Surgery is considered if medicine is not tolerated or does not work well enough. In selected people who have had years of control, the team may discuss carefully stopping treatment.

  • Will I need surgery?

    It depends on the type. Surgery through the nose is commonly the first step for non-functioning tumours affecting vision, for acromegaly and for Cushing disease. Prolactinomas are usually treated with medicine first. Your pituitary team will explain the reasoning for your tumour.

  • Will I need hormone tablets for life?

    Some people do. It depends on how much normal pituitary function is left after the tumour and its treatment. Function is rechecked after surgery and periodically afterwards, and after radiotherapy deficiencies can appear slowly over many years.

  • What is pituitary apoplexy and how quickly must I act?

    Apoplexy is sudden bleeding into, or loss of blood supply to, a pituitary tumour. It causes abrupt severe headache, often with visual loss or double vision. It is an emergency: call 999 or go to A&E. Treatment includes hydrocortisone and urgent specialist review.

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