Can Pituitary Tumors Cause Ear Problems?

What Is The Pituitary Gland?

The pituitary gland is a small endocrine organ located near the base of the brain, beneath the hypothalamus [2]. It comprises two distinct regions: the anterior pituitary and posterior pituitary [2]. The primary function of the pituitary gland is the creation and secretion of hormones, which are molecules that travel via the bloodstream to distant body sites in order to regulate various cellular activities. The pituitary gland is sometimes referred to as the “master gland” of the endocrine system because it secretes a large number of hormones that act on a wide variety of other organs [3].

Some hormones released by the pituitary gland include:

• Growth hormone (GH)
• Follicle stimulating hormone (FSH)
• Lutenizing hormone (LH)
• Thyroid stimulating hormone (TSH)
• Adrenocorticotrophic hormone (ACTH)
• Antidiuretic hormone (ADH) or Vasopressin

Pituitary Tumors: Prevalence, Symptoms, and Diagnosis

Prevalence of Pituitary Tumors

Pituitary tumors (pituitary adenomas) are relatively common within the population and often do not cause serious issues. In fact, most pituitary glands are diagnosed incidentally during the course of imaging for other medical reasons [1]. The “insidious” or “invisible” nature of pituitary tumors makes it difficult to ascertain exactly how prevalent they are, since many individuals may be living with undiagnosed pituitary tumors [1]. A 2023 meta-analysis approximated that pituitary tumors are present within 10% of the population upon imaging or autopsy [4]; however, estimates of prevalence vary within the literature.

Pituitary tumors can come in several different forms and are classified based on either their size or the cell type from which they originated [1].

Symptoms of Pituitary Tumors

The symptoms associated with a pituitary tumor depend on the tumor’s size and whether the tumor is functioning or nonfunctioning [1].

Microadenomas typically do not cause noticeable symptoms and are usually discovered incidentally through brain imaging [1].

Nonfunctioning macroadenomas may lead to headaches and visual disturbances due to pressure generated on surrounding cranial nerves. They may also lead to facial changes, such as a drooping eyelid on one side of the face [4]. Moreover, nonfunctioning macroadenomas can disrupt hormone secretion due to physical compression of nearby secretory cells, leading to deficiencies in growth hormone, gonadotropins, thyroid stimulating hormone, and adrenal corticotropic hormone. This can lead to symptoms like stunted growth; amenorrhea or erectile dysfunction; weight gain, fatigue, and constipation; and weight loss, fatigue, hypotension, dizziness, and vomiting, respectively [1].

Functioning macroadenomas can cause diverse symptoms depending on the type of secretory cell involved [1].

• Prolactin-secreting adenomas negatively regulate gonadotropin levels, which can lead to infertility, diminished libido, loss of bone density, amenorrhea (in females) and erectile dysfunction (in males).
• GH-secreting adenomas cause a condition known as acromegaly. Patients with GH-secreting adenomas frequently present with enlarged facial features, enlarged tongues, and protrusion of the lower jaw (prognathism) and forehead (frontal bossing). GH-secreting adenomas can also cause headaches, visual changes, excessive sweating (hyperhidrosis), unexplained growth of fingers or feet, and hypertension.
• ACTH-secreting adenomas cause a condition called Cushing disease. These tumors typically entail symptoms such as weight gain, easy bruising, susceptibility to bone fractures, and muscle weakness. Visually, patients with Cushing disease often present with a round face, facial plethora (excessive blood flow to the face, leading to swelling and flush), excess fat above the collarbones (supraclavicular adipose tissue), and purple striations on the abdomen and armpits.
• TSH-secreting adenomas lead to excessive thyroid activity and dysregulated metabolic function. This can lead to symptoms such as heart palpitations, cardiac arrhythmias, weight loss, tremors, and thyroid goiter.

Diagnosis of Pituitary Tumors

The majority of pituitary tumors are diagnosed incidentally during CT or MRI scans for other conditions. If a pituitary adenoma is detected via scanning, further biochemical assessments may be recommended to assess the nature of the tumor. This often involves various endocrine assays to evaluate blood levels of prolactin, TSH, T4, FSH, GH, ACTH, estradiol, testosterone, and cortisol [1].

Can A Pituitary Tumor Cause Ear Problems?

So far, we have covered various symptoms associated with functioning and nonfunctioning pituitary tumors. But can a pituitary tumor cause ear problems?

Pituitary Tumors: Ear Pain and Ear Pressure

Can a pituitary tumor cause ear pain? In most cases, pituitary adenomas do not present with ear pain or increased pressure within the ears. However, because nonfunctioning macroadenomas can generate physical pressure on nearby cranial nerves, it is possible that pituitary tumors could generate pain in facial areas including the sinuses and areas surrounding the ears [5]. Nevertheless, this pain is more likely to be felt as pain around the ears rather than the internal pain or pressure typically felt with conditions such as ear infections. Current evidence suggests that it is very unlikely that pituitary tumors cause ear pain or ear pressure [6].

Pituitary Tumors, Tinnitus, and Hearing Loss

Tinnitus is a condition where an individual experiences a sensation of ringing in the ears. At present, pituitary tumors are not known to cause changes in hearing or induce tinnitus. However, there is evidence that surgical removal of pituitary tumors can, in rare cases, lead to hearing loss [7]. This disruption in aural function is associated with the process of removing the tumor rather than the presence of the tumor itself.

Notably, other types of tumors that affect the base of the brain can cause hearing disturbances. For example, acoustic neuromas are a type of benign neoplasm affecting the vestibulocochlear nerve, which is involved in regulating balance and hearing [8]. Due to the involvement of the vestibulocochlear nerve, such tumors can disrupt hearing and present with ear problems. Acoustic neuromas are relatively rare and are distinct from pituitary tumors.

Conclusion

The pituitary gland is an essential regulator of endocrine function and physiological function. Despite its diminutive size, this gland is responsible for the synthesis and secretion of a large number of important hormones, including growth hormone, gonadotropins, adrenocorticotropic hormone, thyroid stimulating hormone, and antidiuretic hormone. Consequently, the pituitary gland plays key roles in regulating reproductive health, general metabolism, and blood pressure. Tumors of the pituitary gland can disrupt these essential processes, leading to disturbances in sexual function, weight maintenance, blood pressure, cardiac function, and energy regulation, among others. Pituitary tumors are surprisingly common and often considered to be “insidious” growths because they can progress without causing overt symptoms. In fact, most pituitary tumors are discovered incidentally during the course of a CT or MRI scan. While small pituitary tumors often do not cause symptoms, larger growths can lead to more serious concerns. In this article, we discussed several of these concerns; however, it is worth noting that ear pain, ear pressure, and hearing loss are not common outcomes of pituitary tumors. Instead, tumors of the vestibulocochlear nerve called acoustic neuromas are more likely to lead to changes in hearing and cause ear problems.