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Date issued: April 2024

For review: April 2026

Ref: A-441/TM/Neurosurgery/Pituitary Tumours v3

PDF: Pituitary Tumours.pdf [pdf] 272KB

Introduction

Welcome to the South West Neurosurgical Centre. This leaflet is designed to give you information to prepare you for your operation. It will explain what will happen while you are in hospital, the before and after operation care, discharge home and the treatment you may need after your operation. It will also answer some of your questions.

What is the Pituitary Gland?

The pituitary gland is normally a small gland about the size of a pea in the centre of the brain behind the top of the nose. The pituitary gland produces hormones to help control other glands in your body. 

What is a Pituitary Tumour?

A pituitary tumour is a growth in the pituitary gland. It can be large or small. There are two groups: one that produces hormones and one that does not. The tumour is not typically a cancer but a non-cancerous benign tumour.

Why do you need an operation?

• You may need surgery to remove the tumour tissue that is over producing hormones.

• You may have a problem with your sight due to the tumour pressing on the tissue that is used to help you see.

• The tumour may be large and pushing on surrounding tissue in your brain.

The aim of the operation is to remove the tumour and leave some of the pituitary gland behind. Sometimes this is not possible and the pituitary gland will have to be removed.

Before the operation

A pre-operative assessment will be arranged for you on

Tests will be performed to prepare you for theatre, including:

• Blood tests
• A heart tracing (ECG)
• A chest X-ray
• Your weight recorded.

You may also need to have a CT scan of your head. This can often be arranged at your local hospital if you live far from Derriford Hospital.

When will the operation be?

You will receive a letter with a date for your operation. You will be asked to come to Postbridge Ward (Level 4) on the morning of the surgery. The exact time will be confirmed depending on your position on the operating list but is usually 7am. In exceptional circumstances there may not be a bed in the hospital and this will mean your operation may be rescheduled. This will not affect your position on the waiting list. 

How do I get to hospital?

You will need to find your own way into hospital. If you are unable to get into hospital and feel you need transport provided, contact your GP to organise this for you. Please note that this is a service based on a medical need only.

You will be met at the door of Postbridge by the nursing team. They will guide you through the next steps in preparation for your surgery. Unfortunately, it is still possible that your surgery may not go ahead, even at this stage in the process.

The day of your operation

You will be asked not to eat or drink anything from midnight unless your operation is in the late afternoon, when your anaesthetist may say you can have a light early breakfast. 

Pre-operative checks will be performed on Postbridge ward and an Anaesthetist, the person who will give you your anaesthetic (put you to sleep), will see you.

You will be asked and get into a theatre gown (provided by the hospital).  A nurse will help you with this if you need them to. Bring a dressing gown to preserve your modesty while walking to the anaesthetic room. You will be asked to remove any jewellery you may be wearing, except for your wedding ring, which may be left on and taped to your finger. The nurse will also help you to put on anti-embolic stockings to help prevent you from developing a blood clot in your legs.                          

The operation

Once you have been put to sleep and are unable to feel anything. The surgeon will access the tumour through your nose.

What happens after the operation?

You will wake up in the recovery area. It is important to monitor your recovery.  You may be monitored in recovery for 4 hours or be transferred to High Dependency Unit (HDU) (Pencarrow ward on Level 4). This simply means we can monitor you more closely than on an ordinary ward after your operation.  You will be subsequently transferred to Erme ward.  You will be sat up in bed and there will be a nurse caring for you. After your operation the nurse caring for you will ask if they can perform some observations. This will include having your blood pressure, pulse, temperature, rate of breathing and oxygen levels taken.  They will also ask you some simple questions about where you are, the date etc. The nurse will also need to check your vision and look into your eyes with a small torch. You may be wearing an oxygen mask to make sure you have a good level of oxygen in your body after your surgery.  You may find you have a dry mouth and the taste of blood in your mouth. 

This is normal and the nurse will give you water, mouth swabs and mouth wash to keep your mouth clean. You may have stitches and a dressing on your thigh or abdomen. The stitches will dissolve in 5 to 7 days. 

You will be able to eat and drink after the operation but may have a drip connected to your arm or neck to keep your fluid levels up. You may find that you have a urine catheter. (A tube that goes into your bladder through the opening you would normally pass urine, that collects urine into a bag). If you do not have one of these you will have to tell the nurse when you want to pass urine and they will assist you with a bedpan or urine bottle.  If you have a catheter this will be removed a day after surgery. You may need some help with washing and dressing and the nurse caring for you will help you if required. While you are in bed the nurse will ask you to change your position every 2 to 3 hours to stop you from getting any sore areas of skin and help your circulation (blood flow around your body.) The nurse will closely monitor how much you drink and how much urine you pass. You will experience some pain and tenderness after your operation, which the nurse will monitor. You will be given you pain killers either as an injection, tablet or a suppositories (given via your rectum/bottom.) 

What problems or risks are involved?

With any surgery there is always a risk or complications associated. One of the risks of this type of surgery is a leak of fluid known as Cerebrospinal Fluid (CSF). This can be caused if a membrane surrounding your brain is opened during surgery. The surgeon may place a piece of fat taken from your thigh or abdomen to seal the leak during the operation. 

If the tumour causes problems with your sight, or the tumour is very large, there is a 1 in 300 chance you may lose your sight and it will not return.

This type of surgery can cause you to produce too much urine (which is why the nurses monitor your urine very closely). This is known as diabetes insipidus. If you have this you may feel extremely thirsty and will probably pass large amounts of urine. This happens because your pituitary gland is not producing enough of the hormone that controls your urine.  This is not normally permanent but you may require treatment called DDAVP to slow down the production of urine.

It is normally given by a small injection.

The remaining pituitary gland may not function normally after surgery. This may mean that you will need to take hormone replacement therapy for the rest of your life. 

When can I be discharged from hospital? 

You may be in hospital for up to 5 days though this will depend on your recovery and your surgeon’s advice. You will probably need to take 4 to 6 weeks off work.

Going home

Your nose may feel blocked and you may experience some discharge of mucous, blood clots and crusting for several days. This can last for several weeks after endoscopic pituitary surgery and longer when a nasoseptal flap becomes necessary during surgery in order to close a leak of Cerebrospinal Fluid (CSF). Nasal crusting can be minimised by the regular use of nasal douches to wash out the nose two or three times daily. Start douching one week after surgery and continue for six weeks. Nasal douches are effectively delivered using the NeilMed Sinus Rinse system, which can be purchased from your local chemist or online prior to surgery.

• Avoid blowing your nose for 2 weeks after surgery.

• Avoid heavy lifting, bending or straining on the toilet; these activities will increase the likelihood of nasal bleeding or leakage of Cerebrospinal Fluid (CSF) from your nose.

• Sit in a recliner or use two or three pillows when sleeping. Take it easy; listen to your body, eat and drink normally.

• Avoid swimming with the head below the water for three months due to risk of infection.

We recommend you space out your activities at first and give yourself plenty of rest periods. You may increase your activities as you are able to tolerate them and as your endurance increases.

Seek advice if you notice:

• Leakage of clear fluid from your nose, or are frequently swallowing liquid from the back of your throat, which may have a salty taste.

• Excessive bleeding from your nose as this symptom could indicate an impending emergency.

• Onset of headache with a temperature and neck stiffness.

• Difficulty with vision or deterioration in your vision.

• You are passing large amounts of urine with excessive thirst and / or you start to feel generally unwell and excessively tired a week or two after your surgery. This may be due to disturbance of the body’s salt levels.

Will I need treatment after the operation?

If you had a large tumour before your operation you may need a course of radiotherapy. This does not mean you have cancer. Radiotherapy can be used to reduce the size of the tumour and the risk of the tumour coming back.

We will contact your GP and ask that your electrolyte levels are checked one week after discharge from hospital. Everyone who has had this surgery will need to have tests to check that their hormone levels are at the correct level. This is normally done at 6 weeks and is performed by your Endocrinologist at your local hospital.

You will also be given Hydrocortisone tablets. The hospital will advise you about this on discharge, so you know how long you should take these for.

The general trend for appointments is as below:

• One week from surgery have a blood test and urine test

• locally (at your GP or local hospital).

• Endocrine blood testing: six weeks.

• Endocrine clinic: eight weeks.

• MRI: three months (when you have received your

• appointment for MRI please contact Mr Muquit’s secretary (Tina 01752 437667 or tina.o'farrell1@nhs.net) so that she can confirm the neurosurgical clinic appointment).

• Neurosurgery: four months.

• Ophthalmology (if required) eight weeks.

There is a lot of information here; it is not intended that this will answer all your questions, so if you have any further questions, please do ask.

Useful contacts

Tracy Mason: Base of Skull Specialist Nurse

• 01752 433239

Tina O’Farrell: Mr Muquit’s secretary

• 01752 437667
• tina.o'farrell1@nhs.net

Pre-Assessment Ward

• 01752 431990

Postbridge Admissions Ward

• 01752 431225

Pencarrow ICU/HDU Unit

• 01752 431439

Erme Post-Operative Neurosurgical Ward

• 01752 438114