Signs and symptoms of macroadenomas and pituitary carcinomas: Pituitary carcinomas are rare cancers usually found after they cause visual problems or other neurologic symptoms. Benign macroadenomas (tumors larger than 1 cm), whether functional or not, can also lead to neurologic symptoms that may include:

• paralysis of eye movements causing double or blurred vision
• loss of peripheral vision
• sudden blindness
• facial numbness or pain
• headache
• dizziness
• loss of consciousness

Vision problems occur when the tumor "pinches" the nerves that extend between the eyes and the brain. Sudden loss of vision, loss of consciousness, and even death can result from sudden bleeding into the tumor.

Macroadenomas and pituitary carcinomas can destroy normal pituitary tissue, resulting in a shortage of one or more pituitary hormones. Depending on which hormones are affected, the symptoms might include:

• nausea
• weakness
• unexplained weight loss or weight gain
• amenorrhea (no menstrual periods)
• erectile dysfunction in men, also known as impotence (difficulty having erections)
• decreased interest in sex, mainly in men

Signs and symptoms of growth hormone-secreting adenomas: The major symptoms of these are directly related to growth hormone overproduction. The effects of excessive growth hormone levels on children and adults are quite different.

In children, high growth hormone levels can stimulate the growth of nearly all bones in the body. The medical term for this condition is gigantism. Its features typically include:

• being very tall (sometimes over 7 feet)
• very rapid growth
• joint pains
• increased sweating

The long bones of adults (especially in the arms and legs) cannot grow further, even when growth hormone levels are very high. But bones of the hands, feet, skull, face, and jaws can grow throughout life. This is why adults with growth hormone-secreting adenomas do not grow taller and develop gigantism. Instead, they develop a different condition called acromegaly. The signs and symptoms of acromegaly are:

• growth of the skull, hands, and feet leading to increase in hat, shoe, glove, and ring size
• deepening of the voice
• change in the appearance of the face (due to growth of facial bones)
• wider spacing of the teeth (due to jawbone growth)
• joint pain
• increased sweating
• development of diabetes mellitus (high blood sugar)
• kidney stones
• heart disease
• headache
• thickening of tongue and roof of mouth, leading to sleep disturbances, including snoring
• thickened skin
• increased growth of body hair

These changes can occur quite slowly, and often people don�t recognize how they�ve changed until they look at an old picture of themselves (or try to remove an old wedding band).

Signs and symptoms of corticotropin (ACTH)-secreting adenomas: Excessively high ACTH levels stimulate the production of several steroid hormones by the adrenal gland. Oversupply of these steroid hormones causes several symptoms that doctors group together as Cushing syndrome. When this originates from the high ACTH production from the pituitary it is termed Cushing disease. In adults, these symptoms include:

• unexplained weight gain (mostly in the chest and abdomen)
• purple stretch marks on the abdomen
• new or increased hair growth (on the face, chest, and/or abdomen)
• swelling of the face
• fat deposits at the point where the back of the neck joins the spine
• moodiness or depression
• easy bruising
• new onset of diabetes mellitus (high blood sugar)
• hypertension (high blood pressure)
• irregular or absent menstrual periods
• osteoporosis (weakening of bones, sometimes leading to fractures)

Most of the adult symptoms can also occur in children. The problem should be considered in any child that gains weight, stops growing taller, and has mood changes or a decrease in school performance. These changes occur much faster than acromegaly, so they are more easily recognized.

Signs and symptoms of prolactin-producing adenomas (prolactinomas): Prolactinomas are most common in young women and older men. In adult women, high prolactin levels cause menstrual periods to stop and can cause abnormal breast milk production, called galactorrhea. In men, impotence (not being able to have an erection) or loss of interest in sex may be the first symptom. If this isn�t examined and the tumor is allowed to grow, then headaches and vision problems will occur. Prolactinomas may be difficult to spot in children.

Signs and symptoms of thyrotropin-secreting adenomas: When the tumor secretes thyroid-stimulating hormone (TSH), it causes the thyroid gland to make too much thyroid hormone. Patients usually have symptoms of hyperthyroidism (overactive thyroid), such as:

• rapid heartbeat
• tremor (shaking)
• weight loss
• increased appetite
• feeling warm or hot
• difficulty falling asleep
• anxiousness
• frequent bowel movements
• lump (enlarged thyroid) in the front of the neck

Signs and symptoms of gonadotropin-secreting adenomas: These adenomas make luteinizing hormone (LH) and/or follicle-stimulating hormone (FSH). They are not very common. Their overproduction of LH and/or FSH may cause irregular menstrual periods in women. Before these adenomas are detected, they may become large enough to cause headaches and problems with vision.

General signs and symptoms of all adenomas and nonfunctional (or null cell) adenomas: Symptoms from these tumors develop when they grow large enough to cause headaches and visual problems. Patients develop symptoms only after the tumor is large enough to affect nearby tissues. These tumors can often reach a large size before they are noticed because no excess hormone is being produced and the patient has no symptoms.

Because not all hormones are being overproduced in secreting adenomas, some symptoms can be due to a loss of normal pituitary hormone production. This will lead to a lack of normal body hormones such as cortisone, thyroid hormone, and sex hormones.

Nonfunctional adenomas that cause no symptoms are sometimes found because of an MRI taken for other reasons. These "incidentalomas." are being discovered more often as more MRI and CT scans of the brain are done. These may be the most common pituitary tumors. They probably do not need treatment.

Diabetes Insipidus

This syndrome is mentioned separately because it can occur with any macroadenoma or with pituitary carcinoma. Diabetes insipidus also can occur as a complication of any pituitary tumor treatment. It should not be confused with diabetes mellitus (high sugar levels in the blood and urine).

Diabetes insipidus results when the pituitary makes too little vasopressin (also called antidiuretic hormone, or ADH), which in turn causes frequent urination, often severe. As a result, the person becomes very thirsty as the body tries to keep up with the loss of water. If severe and untreated, this problem causes blood mineral abnormalities, leading to coma and death. Fortunately, this condition is easily treated with a drug that replaces the vasopressin.