Pituitary Tumor Surgery in Turkey: Endoscopic Approach

In short

What Is Pituitary Tumor Surgery?

Pituitary tumor (tumour) surgery removes a growth from the pituitary gland under the brain. Today, surgeons usually reach it through a nostril, often with an endoscope, a thin camera. Doctors call this endoscopic transsphenoidal surgery, and it leaves no cut on the face.

Most pituitary tumors are benign adenomas that grow slowly and do not spread. However, they still cause trouble in two ways. Some press on the optic nerves, while others make too much of one hormone.

Surgery is not the first step for every tumor, though. For example, prolactinomas usually shrink with tablets. So Prof. Albayrak matches the plan to the tumor type, its size and your vision.

At a Glance

Usual routeThrough a nostril with an endoscope, with no cut on the face
Usually benignMost pituitary tumors grow slowly and do not spread
Tablets first for prolactinomaMedicine controls most of these tumors without surgery
Three aimsFree the optic nerves, control hormones and protect the gland
Hospital stayUsually a few days, then recovery near the hospital
Flying homeUK aviation guidance advises about 7 days after neurosurgery

The pituitary sits at the center of the skull base. Other tumors there also have their own guides: skull base tumors and acoustic neuroma surgery.

Start with your situation

Where Are You in Your Decision?

Pick the line closest to your situation first. Each link then opens the part of this guide written for it.

01A scan found a pituitary tumor by chanceWhether a small, silent tumor needs any treatment
02Your side vision is narrowingWhy pressure on the optic nerves often calls for surgery
03Tests show too much growth hormone or cortisolAcromegaly and Cushing's disease
04You have a prolactinomaWhen tablets come first and when surgery helps
05The tumor grew back or bled suddenlySecond operations, radiation and emergencies
06You plan surgery from abroadLength of stay, flights and hormone care at home

Candidates

Who Needs Pituitary Tumor Surgery?

Surgery helps most when a tumor presses on the optic nerves. It also comes first for tumors that make too much growth hormone or cortisol. Most prolactinomas, in contrast, shrink with tablets alone.

A tumor found by chance

Pituitary tumors are common, and many never cause symptoms. In fact, MedlinePlus notes that 10% to 20% of people may have one.

So a small tumor without hormone or vision problems often needs only follow-up. Doctors then repeat the MRI and blood tests, as many such tumors do not grow.

Narrowing side vision

The optic nerves cross just above the pituitary gland. So a large tumor that grows upward presses on them, and side vision fades first. For example, many people notice it only when they miss a car at their side.

In this situation, surgery is often the right step. Pressure that lasts too long can damage vision for good. In fact, blindness is the most serious risk.

Too much growth hormone or cortisol

A tumor that makes growth hormone causes acromegaly, with growing hands, feet and facial features. According to the NIDDK, a pituitary adenoma lies behind more than 9 in 10 cases.

A tumor that makes ACTH, in turn, drives the body to make too much cortisol. Doctors call this Cushing's disease. Typical signs include a rounder face, weight gain around the trunk and purple stretch marks.

For both, surgery usually comes first. Success then shows in blood tests, not only on the next scan.

Prolactinoma: tablets usually come first

A prolactinoma makes too much prolactin, the hormone behind breast milk. It accounts for about 40% of pituitary tumors, the largest single group.

Medicines called dopamine agonists, such as cabergoline, lower prolactin and shrink the tumor. In small prolactinomas, they normalize prolactin in about 4 of 5 patients.

Surgery becomes an option when the tablets cause side effects or stop working. Some women with a large prolactinoma also choose surgery before a pregnancy.

Regrowth, leftover tumor or sudden bleeding

Pituitary tumors can come back after treatment. Depending on the type, a second operation, medicine or radiation then follows.

Rarely, a tumor bleeds or loses its blood supply, which doctors call pituitary apoplexy. It causes a sudden, severe headache and often vision loss, so it needs emergency care.

Questions at this stage

Is a pituitary tumor cancer?

Almost never. Nearly all are benign adenomas, which do not spread to distant organs. In fact, very few pituitary tumors turn out malignant, according to the National Cancer Institute.

Can a pituitary tumor be treated with medicine?

Sometimes. Prolactinomas usually respond well to tablets, and medicines also help control acromegaly. Most other tumors that need treatment, however, need surgery first.

Act early

When to See a Doctor and When It Is Urgent

Most pituitary tumors grow slowly, so a routine visit is the right first step. A few signs, however, need urgent help the same day.

Book a doctor's visit if you notice:

Side vision that slowly narrows
Periods that stop, or milky breast discharge without pregnancy
Lower sex drive or erection problems
Growing hands and feet, or a changing face
Weight gain in the face and trunk with purple stretch marks

Get urgent medical help for:

A sudden, severe headache, the worst of your life
Sudden vision loss, double vision or a drooping eyelid
Vomiting or fainting with a known pituitary tumor
After surgery: clear, watery fluid dripping from the nose
After surgery: fever, or extreme thirst with heavy urination

The first three can mean pituitary apoplexy, which may need cortisol and emergency surgery. For signs of tumors elsewhere in the brain, see brain tumor symptoms.

Treatment

Pituitary Adenoma Treatment Options Compared

The right option depends on the tumor type, its size and your vision. So the table runs from the gentlest choice to radiation.

Option	Best suited for	How it works	Recovery	Main drawbacks
Follow-up scans (watchful waiting)	Small tumors with no hormone or vision problems	Repeat MRI and blood tests over time	None; daily life goes on	Treatment starts only if the tumor grows or makes hormones
Medicines	Prolactinoma (first choice); some cases of acromegaly or Cushing's disease	Tablets or injections lower hormone levels, and some shrink the tumor	No hospital stay	Often long-term use; side effects such as nausea or dizziness
Endoscopic transsphenoidal surgery	Most tumors that need surgery, including those pressing on vision	A thin camera through a nostril; no cut on the face	A few days in hospital; the nose heals over weeks	Fluid leak, temporary diabetes insipidus, low hormone levels
Microscopic transsphenoidal surgery	The same group; the choice depends on the surgeon's training	An operating microscope through the nose or under the upper lip	Similar to the endoscopic route	Risks and results similar to the endoscopic route (NIDDK)
Craniotomy (open surgery)	Very large tumors that spread where the nose route cannot reach	An opening in the skull	Longer hospital stay and recovery	Risks of open brain surgery; in the UK, 6 months off driving
Radiosurgery or radiotherapy	Tumor left after surgery, regrowth, or people who cannot have surgery	Focused radiation in one session, or daily over 4-6 weeks	No hospital stay	Works slowly, over years; about half of patients later need hormone tablets (NIDDK)

Prof. Albayrak sets three aims for every plan. First, stop the excess hormone, and second, free the optic nerves. Third, protect the healthy pituitary tissue.

For most tumors that need surgery, he uses the endoscopic route through the nose. However, a very large tumor may spread beyond its reach, and then open surgery helps.

Which is better, endoscopic or microscopic pituitary surgery?

Both reach the tumor through the nose, and NIH information reports similar risks and results. An endoscope also gives a wider view, and NICE found shorter operating times. In both, success depends largely on the surgeon's skill and experience.

Risks

What Are the Risks of Pituitary Surgery?

Every pituitary operation carries risks, since it works near the optic nerves and major arteries. The main ones, according to NIH and NICE information, are these:

A leak of brain fluid (CSF) through the nose, which may need bed rest or a repair
Diabetes insipidus: heavy urination and strong thirst, often temporary
Low levels of other pituitary hormones, which may need tablets
Swings in blood sodium and water balance
Infection, including meningitis, and bleeding
Rarely, injury to the optic nerves or the carotid artery
Nose problems such as sinusitis or a small hole in the nasal septum

To prevent a leak, the surgeon then seals the opening in the bone. Often, a little fat and tissue glue do this job. The team also watches urine, thirst and blood sodium closely in the first days.

Results

What Results Can Pituitary Surgery Achieve?

Results depend most on the tumor type and size, and on the surgeon's experience. Smaller tumors also give the best chance of full control.

Tumor type	Usual first treatment	What counts as success	NIH figures (NIDDK)
Prolactinoma	Tablets (dopamine agonists)	Normal prolactin and a smaller tumor	Tablets: about 4 in 5 small tumors. Surgery: about 90% of small and 50% of large tumors
Growth hormone tumor (acromegaly)	Surgery	Normal growth hormone and IGF-I levels 12 weeks after surgery	About 85% of small and 40-50% of large tumors right after surgery
ACTH tumor (Cushing's disease)	Surgery	Normal cortisol levels	Up to 90% with a highly experienced surgeon
Nonfunctioning tumor	Surgery if it presses on the optic nerves; otherwise follow-up	Relief of pressure and protection of the gland	No single figure; MRI follow-up, and radiation if it regrows (NCI)

These are general NIH figures, not the results of one surgeon. So ask any surgeon what their own figures mean for your tumor.

Side vision often improves once the pressure comes off the optic nerves. However, the longer the pressure lasted, the less vision may return.

What is the success rate of pituitary tumor surgery?

It depends on the tumor type and size. For example, NIH figures show cure in about 85% of small growth hormone tumors. For large tumors, rates are lower, so medicine or radiation may follow.

International patients

Coming to Istanbul from the US, Canada, the UK or Europe

Pituitary surgery abroad needs one extra plan: who takes over your hormone care at home. So line up a local endocrinologist before you travel.

How Long to Stay and When to Fly

Your stay covers tests, the operation, a few days in hospital and recovery nearby. Neurosurgery can leave gas trapped inside the skull, and this gas expands at altitude. So the UK Civil Aviation Authority advises about 7 days before flying.

Flying soon after surgery also raises the risk of blood clots, says the US CDC. For major surgery, it suggests waiting 10-14 days because of cabin pressure changes. In practice, plan about two weeks in Istanbul and book a flexible ticket.

Hormone Care Back Home

Before you fly home, collect these papers for your endocrinologist and family doctor:

A discharge summary with the operation and the tumor type
Copies of your scans, hormone results and the tissue report
A list of every medicine, with its purpose

If you go home on cortisol tablets, learn when to take an extra stress dose. MedlinePlus also advises carrying a medical ID that names the medicine. After surgery for Cushing's disease, for example, you may stop them after 6-18 months.

Driving, Insurance and Visas

In the UK, the DVLA says not to drive after transsphenoidal surgery until you recover. You may then drive again if no serious visual field loss remains. In the US, rules vary by state, so ask your doctor first.

From Canada, check with your provincial health plan and private insurer before you book. Medicare, NHS and visa rules also appear in the guide to brain surgery in Turkey.

Your treatment path

From First Tests to Hormone Follow-Up

Pituitary treatment follows four steps. Each step answers one practical question, so you always know what comes next.

01 Tests
02 Consultation
03 Surgery
04 Recovery

STEP 01

Tests: confirm the tumor type first

The tumor type decides the treatment, so tests come before any choice. Three groups of tests usually complete the picture:

Hormone blood tests: prolactin, growth hormone (IGF-1), cortisol, thyroid and sex hormones
Pituitary MRI with contrast: the tumor, the optic nerves and nearby arteries
Eye exam with a visual field test: any loss of side vision

In Cushing's disease, a small tumor may not show on MRI. Blood samples from the veins that drain the pituitary then confirm the source.

Other growths near the pituitary can look similar on MRI. Examples include a craniopharyngioma, a meningioma and a Rathke cleft cyst. However, hormone tests and the MRI pattern usually tell them apart before surgery.

Does a pituitary tumor show on a CT scan?

Large tumors often do, but small ones may not. MRI shows the gland in much finer detail, so doctors prefer it. CT helps when you cannot have an MRI, for example with some metal implants.

STEP 02

Consultation in Istanbul: agree on the plan

Prof. Albayrak examines you at his clinic in Terrace Fulya Center, Teşvikiye. He goes through your MRI, hormone results and eye tests with you. Then he explains each option, its risks and the recovery.

If tablets or follow-up scans suit you better, he tells you so. The plan also covers hormone care with an endocrinologist, before and after surgery.

These questions help at this visit:

Does my tumor make a hormone, and which one?
Does it touch the optic nerves?
Do tablets suit me, or do I need surgery?
Will I need hormone tablets afterward?

What should I bring to my appointment in Istanbul?

Bring your MRI scans on a disc or USB drive, with the written reports. Add all hormone results, eye test reports and a list of your medicines. Notes from any earlier operation help, too.

STEP 03

Transsphenoidal surgery through the nose, step by step

Surgery takes place in a hospital in Istanbul, which Prof. Albayrak names at the consultation. Under general anesthesia, it follows these steps:

The surgeon passes a thin endoscope through one nostril
Next, the surgeon opens the sphenoid sinus behind the nose
A small window in the sella, the bony pocket that holds the gland, leads to the tumor
Guided by navigation, the surgeon removes the tumor in small pieces and protects the normal gland
Finally, the surgeon seals the opening, often with a little fat and tissue glue

Is pituitary surgery considered brain surgery?

Yes, neurosurgeons perform it, and it works at the base of the brain. However, the nose route avoids cutting through brain tissue. So recovery is usually quicker than after open brain surgery.

How long does pituitary surgery take?

Usually a few hours under general anesthesia. Large tumors, or tumors that wrap around the arteries, take longer. So ask your surgeon for a personal estimate at the consultation.

STEP 04

Recovery and hormone care

Most people sit up and walk within a day. At first, a stuffy nose and a mild headache are common. Meanwhile, the team checks urine, thirst, sodium and cortisol closely.

First days: checks in hospital, then discharge once sodium and hormones settle
First weeks: rest nearby and avoid bending over, which puts pressure on the head
About 3 months: a full hormone panel and the first follow-up MRI
After that: regular MRI and hormone checks

Before discharge, the team gives written rules for the first weeks. Ask, for example, when you may blow your nose, swim or fly.

How long is recovery after pituitary surgery?

Many people return to light activity within a few weeks. Hormone levels, however, can take months to settle.

Will I need hormone tablets after pituitary surgery?

Some people do, at least for a while. After surgery for Cushing's disease, for example, cortisol tablets often continue for months. Blood tests then show which hormones, if any, you need long term.

Your surgeon

Your Pituitary Surgeon in Istanbul

Prof. Dr. Serdar Baki Albayrak

Neurosurgeon · Full Professor of Neurosurgery

Pituitary surgery works millimeters from the optic nerves and the carotid arteries. So Prof. Albayrak plans it with endocrinology and eye specialists, from first tests to follow-up.

His first-author review of intraoperative MRI (2004) lists pituitary adenomas among its main uses. He trained in neurosurgery at Istanbul University. He then took clinical fellowships in Helsinki and at Harvard Medical School.

27+Years

5,000+Operations

64Countries

33Publications

Figures from Prof. Albayrak's professional profile, September 2026. See his full publication list.

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FAQ

Frequently Asked Questions

Is pituitary surgery dangerous?

Every operation carries risks, and this one works near the optic nerves and major arteries. Common problems, such as thirst or a small fluid leak, are often temporary. Still, ask your surgeon which risks apply to your tumor.

Can a pituitary tumor come back after surgery?

Yes, sometimes, especially when part of the tumor stays behind. For this reason, follow-up MRI and hormone tests continue for years. If it regrows, a second operation, medicine or radiation can help.

Are pituitary tumors hereditary?

Usually not, since most develop by chance. A few run in families, for example with MEN1 syndrome or Carney complex. So tell your doctor if relatives had pituitary or other hormone gland tumors.

Can I get pregnant after treatment for a prolactinoma?

Often, yes. Tablets that lower prolactin very often restore fertility. With a large prolactinoma, however, some women choose surgery before trying to conceive.

Prof. Albayrak's Published Research

Prof. Albayrak's publications below relate to pituitary surgery and its differential diagnosis. His MRI review names pituitary adenomas among its main uses; his chapter covers meningiomas. The full list of his 33 publications is on his profile.

Intra-operative magnetic resonance imaging in neurosurgeryActa Neurochirurgica, 2004 · First author
The Origin of MeningiomasMeningiomas (book chapter, Elsevier), 2010 · First author

Public health information

National Cancer Institute. What Are Pituitary Tumors?
National Cancer Institute. Pituitary Tumors Signs and Symptoms.
National Cancer Institute. Pituitary Tumors Diagnosis and Prognosis.
National Cancer Institute. Pituitary Tumors Treatment.
MedlinePlus. Pituitary tumor.
MedlinePlus. Pituitary apoplexy.
MedlinePlus. Hypopituitarism.
MedlinePlus. CSF leak.
MedlinePlus. Brain surgery: discharge.
NIDDK. Prolactinoma.
NIDDK. Acromegaly.
NIDDK. Cushing's Syndrome.
NICE. Endoscopic transsphenoidal pituitary adenoma resection (HTG14).
UK Civil Aviation Authority. Surgical conditions.
US CDC. Medical tourism.
GOV.UK, DVLA. Neurological disorders: assessing fitness to drive.

This page gives general medical information and does not replace a consultation. Diagnosis and treatment decisions need an examination by your own doctor.

Last updated: 1 October 2026. Website editor: Prof. Dr. Serdar Baki Albayrak's clinic, [email protected].

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