What is pituitary surgery?

Pituitary surgery removes an abnormal growth on your pituitary gland. This gland is located at the base of your brain. It makes important chemicals called hormones. Your body uses these hormones for many functions, including growth, sexual development, reproduction, and metabolism. (Metabolism is the way your body uses food for energy.)

You will be asleep during the surgery. You will not feel pain. The doctor can get to your pituitary gland in one of three ways.

• The doctor makes a cut under your upper lip. This is called an incision. Then the doctor puts a thin, flexible tube called a scope through the incision. The tube has a small camera on the end. The camera helps the doctor find the gland. Next, the doctor uses special tools to cut out the growth and remove it through the incision. Then the incision is stitched up.
• The doctor makes an incision in the back of your nose. You may get another one under your upper lip. Then the doctor puts a thin, flexible tube called a scope through one of these incisions. After the tube reaches the pituitary gland, the doctor uses special tools to remove the growth through your nose. After this surgery, you may not need stitches. The doctor may use a small piece of fat from your belly or thigh to plug up the hole in your nose. This helps prevent spinal fluid from leaking out of your nose. If this is done, you will have a small scar on your belly. It will fade with time. You will not have a scar on your face.
• In rare cases, the doctor makes an incision near the top of your head. The doctor uses special tools to remove bone that is part of your skull. Then the doctor gently makes their way to your pituitary gland. Next, the growth is cut out. Then the doctor replaces the piece of bone and attaches it with metal plates and clamps.

This surgery usually takes about 2 to 3 hours. If the doctor goes under your lip or through your nose, you will probably leave the hospital in 1 to 3 days. You will probably be able to return to work or your normal routine in 1 to 2 weeks. If your doctor goes through your skull, you will probably leave the hospital in 3 to 9 days. But it may take 4 to 6 weeks to fully recover.

After surgery, your symptoms may go away. For example, your vision may improve. Or your headaches may go away. If the growth comes back, or if the doctor could not remove the whole growth, you may need other treatment. This may include radiation therapy.

After the surgery, you may need to take medicines to replace the hormones made by the pituitary gland.

Activity

• Ask your doctor when you can drive again.
• Rest when you feel tired. It is normal to want to sleep during the day. It is a good idea to plan to take a nap every day. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• For 1 to 2 weeks, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Avoid strenuous activities, such as bicycle riding, jogging, weightlifting, and aerobic exercise, for 1 to 2 weeks.
• If you had surgery through your skull:
  • Try not to lie flat when you rest or sleep for the first 1 to 2 weeks after surgery. You can use a wedge pillow, or you can put a rolled towel or foam padding under your pillow. You can also raise the head of your bed by putting bricks or wooden blocks under the bed legs.
  • After lying down, bring your head up slowly. This can prevent headaches or dizziness.
  • You can wash your hair 2 to 3 days after your surgery. But do not soak your head or swim for 2 to 3 weeks.
  • Do not dye or color your hair for 4 weeks after your surgery.
  • Ask your doctor if it is safe for you to travel by plane.
• If you had surgery under your lip or through your nose:
  • Do not blow or pick your nose or cough hard for 4 weeks after surgery. Do not use any medicines that you need to inhale through your nose.
• If you had surgery under your lip:
  • Do not brush your teeth for up to 2 weeks after your surgery. Your doctor will give you swabs to use instead of a toothbrush. You will also get a special mouthwash to rinse with after eating and drinking. The mouthwash helps your incision heal.
  • Do not wear dentures for 2 weeks after surgery.
• You will probably need to take a few weeks off from work. This depends on the type of work you do and how you feel.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Follow your doctor's orders about how much fluid you should drink after surgery.
• Ask your doctor when it is okay to drink alcohol.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take any new medicines as directed.
  • You may need to take hormone medicines.
  • Your doctor may recommend a decongestant medicine.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine with meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have an incision on your belly, thigh, or head:
  • Leave the tape on for a week or until it falls off.
  • Keep the area clean and dry. Change the bandage every 2 days, or if it gets wet or soiled.
  • Do not take a bath or soak the incision in water for 2 weeks.
  • After your doctor says it is okay to shower or bathe, gently wash the surgery area with warm, soapy water and pat it dry.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Pituitary surgery removes an abnormal growth on your pituitary gland. Your pituitary gland is at the base of your brain. It makes important chemicals called hormones. These hormones are involved in many of your body's functions, including growth, sexual development, reproduction, and your metabolism (the way your body uses food for energy).

If you had surgery under your lip or through your nose, you may have a headache and a slight runny nose after surgery. This will get better in 1 to 2 weeks. Your doctor may recommend pain or decongestant medicines to help with these symptoms.

There are other less common symptoms after this type of surgery. You will feel tired, and your front teeth or upper lip may feel numb. You may gain weight. You may also have trouble breathing through your nose. You may have bruises under your eyes or on the side of your nose, and you may not be able to smell as well as usual.

If the doctor used a small piece of fat from your belly or thigh to plug up the hole in your nose, you will have a small scar on your belly or thigh that will fade over time.

You will probably be able to return to work or your normal routine in 1 to 2 weeks. If you had stitches, they will disappear on their own in 7 to 10 days.

If you had surgery through your skull, you will probably feel very tired for several weeks after surgery. You may also have headaches or problems concentrating. It can take up to 6 weeks to fully recover.

The cuts the doctor made (incisions) may be sore for about 5 days after surgery. You may also have numbness and shooting pains near your wound, or swelling and bruising around your eyes. As your wound starts to heal, it may start to itch. Medicines and ice packs can help with headaches, pain, swelling, and itching.

It is common for your scalp to swell with fluid. After the swelling goes down, you may have a dent in your scalp.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 2 to 3 hours.