The pituitary gland, or hypophysis, is a small, pea-sized endocrine organ situated at the base of the brain, resting in a bony pocket called the sella turcica, directly behind the bridge of the nose. Often referred to as the body’s “master gland,” it governs the function of nearly every other endocrine gland, releasing hormones that regulate growth, metabolism, and reproduction. The surgical removal of this gland, a procedure known as a hypophysectomy, is a highly complex intervention. The answer to whether the pituitary gland can be removed is definitively yes, but it is reserved for specific, medically necessary circumstances.
Medical Reasons for Removal
The most frequent reason for surgically removing the pituitary gland, either entirely or partially, is the presence of a tumor. These growths, known as pituitary adenomas, are usually non-cancerous but cause severe problems either by their mass effect or by overproducing specific hormones. A large tumor can press upward on the optic chiasm, the point where the optic nerves cross, leading to significant vision loss that often manifests as a loss of peripheral sight.
In other cases, the tumor is functional, meaning it secretes an excessive amount of a specific hormone, which disrupts the body’s entire endocrine balance. For example, a corticotroph adenoma overproduces Adrenocorticotropic Hormone (ACTH), which then causes the adrenal glands to flood the body with the stress hormone cortisol. This condition, called Cushing’s disease, can lead to severe issues like diabetes, high blood pressure, and bone weakening. Similarly, a somatotroph adenoma secretes too much growth hormone, resulting in acromegaly, causing the enlargement of the hands, feet, and facial features. In rare instances, removal may also be necessary for metastatic cancer that has spread to the pituitary area.
Surgical Techniques Employed
The primary method for accessing and removing the pituitary gland or a tumor is the Transsphenoidal Approach, which utilizes a natural corridor through the nose. This minimally invasive technique avoids the need for an open skull procedure, or craniotomy, which is generally reserved for extremely large or complex tumors that extend beyond the immediate area of the sella turcica. The transsphenoidal procedure is typically performed by a team consisting of a neurosurgeon and an otolaryngologist (Ear, Nose, and Throat surgeon).
The procedure begins with the insertion of a thin, tubular instrument called an endoscope through one of the nostrils. This device contains a camera and light, providing the surgical team with high-definition, magnified views of the surgical field on a monitor. The endoscope is advanced through the nasal cavity and the sphenoid sinus, a hollow air space located behind the nose.
Once the sphenoid sinus is traversed, a small bony window is created in the floor of the sella turcica, the bony encasement that holds the pituitary gland. Specialized, long-handled instruments, such as micropituitary rongeurs, are then passed through the endoscope to carefully remove the tumor or the targeted portion of the gland. This method allows for precise removal while minimizing damage to surrounding structures, such as the optic nerves, which sit directly above the gland.
After the removal is complete, the surgical defect in the sella floor is often reconstructed to prevent a cerebrospinal fluid (CSF) leak, a potential complication of the procedure. Surgeons frequently use a small piece of fat or muscle tissue harvested from the patient’s abdomen or thigh to pack the empty space. This grafting material is secured with surgical glue to seal the area, promoting faster healing and significantly reducing the risk of postoperative complications.
Managing Life After the Procedure
The most significant consequence of a total or near-total hypophysectomy is the resulting condition of panhypopituitarism, which is the loss of all pituitary hormone production. Patients must begin a regimen of Hormone Replacement Therapy (HRT) immediately, which will be a lifelong commitment. Replacement of certain hormones is prioritized to prevent life-threatening complications.
The most time-sensitive replacement is for cortisol, which is managed with oral glucocorticoid medications such as hydrocortisone. Unreplaced cortisol deficiency can lead to adrenal crisis, a severe drop in blood pressure and organ failure. Second in importance is the replacement of thyroid hormone, which is administered as levothyroxine to prevent hypothyroidism, a condition that causes profound fatigue and metabolic slowing.
Patients also often require replacement of sex hormones, such as testosterone for men and estrogen for women, to maintain bone density and sexual function. Growth hormone replacement may also be necessary, particularly in children where it is required for normal development, and is offered to adults to improve body composition and quality of life. A common complication following pituitary surgery is central Diabetes Insipidus (DI), a condition where the body cannot regulate water balance due to a lack of Antidiuretic Hormone (ADH). This is managed by taking the synthetic ADH analog desmopressin, which prevents excessive water loss and severe dehydration. Lifelong monitoring by an endocrinologist is necessary to carefully adjust the doses of these various medications and ensure the body’s hormonal balance remains stable.