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The pituitary gland is at the base of the brain, behind the nose and sinuses. It makes hormones that control growth, sexual function, and fluid balance. It also controls other glands in the body, such as the thyroid gland. Problems can occur when a growth (tumor) forms in the pituitary gland. These tumors are almost always benign (not cancer). But a tumor can cause the pituitary to make too much or too little of some hormones. This can lead to health problems. Or a tumor may press on the nerves to the eyes (optic nerves). This can cause headaches and vision loss. Surgery to remove the tumor can relieve such problems. In most cases, the surgery is done through the nasal passages. This leaves no scars or stitches that can be seen.
Prepare for the procedure as you have been instructed. Be sure to tell your doctor about all medications you take. This includes over-the-counter drugs. It also includes herbs and other supplements. You may need to stop taking some or all of them before surgery. Also, follow any directions you’re given for not eating or drinking before surgery.
The surgery takes about 3 hours. Before the surgery begins:
An IV line is put into a vein in your arm or hand. This line delivers fluids and medications.
To keep you free of pain during the surgery, you’re given general anesthesia. This medication puts you into a state like deep sleep through the surgery.
Just before the surgery, a breathing tube (endotracheal tube) is placed into your throat through your mouth. The tube is usually removed at the end of surgery or soon afterward.
In most cases, surgery is done through the sphenoid sinus. This is one of the air spaces behind the nose. During surgery:
The doctor may use a surgical microscope to get a close-up view of the gland. In this case, a small incision is made in the nose or lip to access the sphenoid sinus and reach the tumor. Or, an endoscope may be used. This is a thin tube with a light and tiny camera on one end. It’s inserted through the nostril and into the sphenoid space to reach the tumor.
Once the tumor has been reached, the doctor will remove it. If the whole tumor can’t be reached, the portion that is left may need to be removed during a later surgery or treated with radiation. If a large tumor is removed, the area may be filled with a small piece of fat taken from your abdomen.
At the end of surgery, any incisions are closed with stitches. These dissolve on their own in a few weeks. A spongy material (packing) and splints may be placed in the nose.
You will be taken to a recovery room to wake up from the anesthesia. Right after surgery, you will have a dressing taped to your nose to absorb drainage. You will be given pain medication. Tell your provider if your pain is not controlled. You are then taken to a hospital room to stay for 1-2 night(s). During your stay:
For the first few days, you will have congestion and a headache.
You may be given a steroid medication. (This is not the same as anabolic steroids used by some athletes.) The medication helps regulate hormone levels that can change as your body adjusts to pituitary surgery. You will gradually taper off the steroid within a week.
For the first day or two after surgery, the amount of urine you produce is monitored closely. This is to check for a condition called diabetes insipidus, which is common after pituitary gland surgery. It causes you to feel thirsty and to urinate more than normal. It usually goes away on its own within a week or so.
Once you are ready to go home, you will be released to an adult family member or friend. Plan to have someone stay with you for the next couple of days to help care for you as your healing begins. Be sure to follow all of your doctor’s instructions. During your recovery:
Take all medications as directed. This includes pain medications, steroids, and other medications you are prescribed. Do not stop taking steroids without talking to your doctor first. Steroids should not be stopped suddenly.
Use a salt nasal spray as directed. This keeps the lining of your nose moist and aids healing.
Avoid sneezing, coughing, or blowing your nose for at least 2 weeks after surgery. If you can’t avoid sneezing, keep your mouth open.
Avoid bending, lifting, or straining for the 4 weeks after your surgery.
Resume normal activities as advised. Try to do a little more each day.
Be sure you have a contact number for your doctor. After you get home, call this number if you have any of the following:
Chest pain or trouble breathing (call 911 or other emergency service)
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Symptoms of infection of the incision, such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
A clear watery drainage from your nose or down the back of your throat
Headaches or other pain not relieved by medication
Dizziness, stiff neck, or sensitivity to light
Loss of vision or double vision
Constant thirst that is not relieved by drinking
More frequent passing of urine than before surgery
Lightheadedness or fainting
Pain or swelling in the legs
During follow-up visits, your doctor will check on your healing:
If you have packing or splints that need to be removed, this may be done about 7 days after surgery.
If some of the tumor was not removed, you may need further surgery or treatment. You will discuss this with your doctor.
About 3 months after your surgery, an eye test and MRI may be done. You will have more imaging tests over time. You will also have blood tests to check your hormone levels. These tests make sure that the tumor has not come back.
Some hormone levels may not return to normal after surgery. If so, medications can be given to control or supplement those hormones. Lifelong monitoring of the gland and your hormone levels is often needed after surgery. Have regular checkups as advised.
Risks of pituitary gland surgery include:
Leaking of the fluid that surrounds the brain and spinal cord (cerebrospinal fluid)
Damage to the pituitary gland
Bleeding or blood clot in the brain
Scarring inside the nose
Loss of sense of smell or taste
Injury to blood vessels
Risks of anesthesia (you will discuss these with the anesthesiologist)