Pituitary tumour surgery

An operation, usually done through the nose, to remove a tumour of the pituitary gland at the base of the brain, often to relieve pressure on the eyes or correct a hormone problem.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

It removes a tumour of the pituitary gland, usually through the nose, often to protect vision or to correct a hormone problem.
Most pituitary tumours are benign and slow-growing, and not every one needs surgery — some are monitored, and some are treated with medicines first.
Hormone levels need careful checking before and after surgery, and some people need long-term hormone replacement; vision is monitored too.
It is delicate skull-base surgery best managed by a specialist team including a neurosurgeon and an endocrinologist, with honest discussion of what it can and cannot achieve.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeSkull-base brain operation, usually through the nose

AnaestheticGeneral anaesthetic

How long it takesOften around 2 to 3 hours

Hospital stayOften about 3 to 5 days

Time off workAbout 4 to 8 weeks; tiredness is common for some weeks

When you'll see resultsSome effects are early; pathology and hormone results take days to weeks; smell and energy settle over weeks

On the NHS?Usually done on the NHS in a specialist pituitary centre; private care is uncommon

A general guide. Your surgeon will give you advice for your situation.

Best fit

Can relieve pressure on the nerves to the eyes and protect or improve vision

Pause if

Your tumour is a type usually treated with medicines first, such as a prolactinoma.

Main recovery point

You are watched closely, with regular checks of hormones, fluid balance and vision. Your nose will feel blocked and may have packing or splints for a...

Good aftercare

Joint follow-up by a surgical and endocrine (hormone) team, with clear hormone-monitoring and replacement plans.

First few days (in hospital)

You are watched closely, with regular checks of hormones, fluid balance and vision. Your nose will feel blocked...

First 1 to 2 weeks

Blood tests check your hormone levels, and you are reviewed by the team. Avoid blowing your nose hard, heavy...

Weeks 4 to 8

Energy gradually returns and most people adopt a gentle lifestyle for this period. The team checks hormones and...

From around 3 months

A scan is often done to see how much tumour was removed, and longer-term hormone and vision follow-up is arranged...

Medical line illustration of neurosurgery brain procedure for Pituitary tumour surgery. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is pituitary tumour surgery?

Pituitary tumour surgery removes a growth on the pituitary gland — a pea-sized gland at the base of the brain that controls many of the body's hormones. Most of these tumours are non-cancerous (benign) and slow-growing, and are called pituitary adenomas, but they can still cause problems by pressing on nearby structures or by making too much of a hormone.

The operation is usually done through the nose (a transsphenoidal approach), often with a small telescope (endoscope), so there is no cut on the head and no shaved hair. The surgeon reaches the pituitary through a sinus behind the nose and removes as much of the tumour as is safe. A sample is sent to the laboratory.

Surgery is usually recommended when a tumour is pressing on the nerves to the eyes and affecting vision, when it is growing, or for certain hormone-producing tumours. It is not always the first or only treatment: some pituitary tumours are watched with scans, and some hormone-producing types (such as prolactinomas) are usually treated with medicines first.

The key point is that this is delicate surgery at the base of the brain, and it is usually managed jointly by a neurosurgeon (sometimes with an ENT surgeon) and a hormone specialist (endocrinologist). What it can achieve, and the risks, depend on the tumour's size, type and exactly where it sits.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Endoscopic transsphenoidal surgery

The most common approach: the tumour is removed through the nose using a small telescope, so there is no cut on the head and recovery is usually quicker than open surgery.

Microscopic transsphenoidal surgery

A similar approach through the nose using an operating microscope rather than an endoscope, depending on the team and the tumour.

Craniotomy (open) approach

Occasionally, larger or awkwardly shaped tumours need to be reached through an opening in the skull instead of, or as well as, the nose.

Debulking versus complete removal

Sometimes the whole tumour can be removed; sometimes only part is taken safely, with medicines or radiotherapy used for the rest.

Surgery versus other options for a pituitary tumour

	Surgery	Other options
Main aim	Remove tumour, protect vision	Shrink, control or monitor
Examples	Transsphenoidal removal	Medicines, radiotherapy, watch and wait
Often first for	Vision pressure, some hormone types	Prolactinomas, small or stable tumours
Gives a diagnosis	Yes, from the tissue removed	Scans and hormone tests only
Decision	Made with a specialist team	Made with a specialist team

Some hormone-producing tumours, especially prolactinomas, are usually treated with medicines first, and some small tumours are simply monitored. A specialist team including an endocrinologist should explain which option fits your tumour.

Preparing for your surgery

See a specialist team, usually a neurosurgeon and an endocrinologist (hormone specialist), to confirm why surgery is recommended for you.
Expect blood tests to check hormone levels, brain scans, and an eye (visual field) test before surgery.
Tell the team about all medicines, especially blood thinners, steroids and any hormone treatment, and any allergies.
Ask whether your tumour might be better treated with medicines or monitoring first.
Arrange about 4 to 8 weeks of a gentle lifestyle afterwards, and support at home, as tiredness is common.
Plan not to drive until your team says it is safe, and arrange a lift home.
Ask what hormone tablets (such as steroids) you may need to take after surgery and how these will be checked.

What happens

The operation is done under general anaesthetic, so you are asleep. Most often the surgeon reaches the pituitary gland through the nose, passing instruments and a small telescope (endoscope) through a sinus at the back of the nose to reach the base of the brain. As much of the tumour as is safe is removed and a sample is sent to the laboratory.

Because the gland sits just below the nerves to the eyes and close to major blood vessels, the surgeon works carefully and may use computer guidance. The operation usually takes around two to three hours. Sometimes a small patch of your own tissue is used to seal the area and reduce the chance of fluid leaking.

Afterwards you may have some nasal packing or splints for a short time and your nose will feel blocked. You are watched closely, and your hormone levels and fluid balance are checked. Most people are in hospital for about three to five days.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Your tumour is a type usually treated with medicines first, such as a prolactinoma.
The tumour is small, not causing symptoms, and can be safely monitored with scans.
Your general health makes a general anaesthetic and skull-base surgery too risky.
The likely benefit to vision or hormones does not outweigh the surgical risks for you.

Delay surgery if…

There is an active infection (including a sinus infection) that should be treated first, where it is not an emergency.
You are on blood thinners that need safe planning before surgery.
Hormone levels need stabilising first (for example, very high cortisol or thyroid problems).
Further scans, hormone tests or vision tests are needed to plan safely.

Alternatives to discuss

Medicines, especially for prolactinomas and some other hormone-producing tumours.
Watchful waiting with monitoring scans for small, stable tumours.
Radiotherapy, including stereotactic radiosurgery, for some tumours or for tumour left behind.
Hormone replacement to manage an underactive gland without surgery in selected cases.
A second specialist opinion before committing to surgery.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

General anaesthetic

Pituitary tumour surgery is done fully asleep under a general anaesthetic.

Benefits

Can relieve pressure on the nerves to the eyes and protect or improve vision
Can reduce the over-production of a hormone for certain tumour types
Provides tissue for an exact diagnosis to guide any further treatment
Usually avoids a cut on the head and a shaved scalp, as it is done through the nose
Can improve symptoms such as headaches caused by a large tumour

Risks & complications

More common

A blocked, sore or runny nose and changes to your sense of smell for some weeks
Tiredness for several weeks, and headache in the early period
Needing hormone tablets (such as steroids) at least for a time after surgery

Less common

A leak of brain fluid (CSF) from the nose, which may need further treatment
Temporary diabetes insipidus (passing large amounts of urine and feeling very thirsty), usually settling but sometimes needing medicine
Long-term shortage of one or more pituitary hormones, needing replacement
Infection, including, rarely, meningitis if fluid leaks

Rare but serious

Permanent diabetes insipidus needing long-term medicine
Damage to vision, including, very rarely, loss of sight
Injury to a major blood vessel, bleeding, or a stroke-like problem
Serious complications that can be life-threatening; death is very rare

The main concerns are leaking of brain fluid, changes to hormone levels (including diabetes insipidus and the need for hormone replacement), and the small risk to vision and major blood vessels. How likely these are depends on the size and position of your tumour. Ask your surgeon about your own risks, and make sure an endocrinologist is involved in checking your hormones before and after.

Published figures to discuss

Risks depend on the tumour's size, type and exactly where it sits, and on your general health. The most useful figures relate to brain-fluid (CSF) leak, diabetes insipidus and hormone replacement; rates vary widely between studies and centres, so the ranges below are cautious and source-based rather than a prediction for you. Serious complications such as major blood-vessel injury, blindness or death are very rare but important, which is why this surgery is done in specialist centres.

Figure	Reported range	How to interpret it	Source / confidence
Permanent diabetes insipidus	Around a few in 100; one systematic review reported a median of 2.7% (IQR 1.9–4.3%)	Temporary diabetes insipidus is more common but usually settles; a brain-fluid leak during surgery raises the risk.	Complications of transsphenoidal surgery — review (PMC)pmc.ncbi.nlm.nih.govPublished figure
Long-term need for hormone replacement	Variable; low for many microadenomas but meaningfully higher after large, invasive or repeat operations	An endocrinologist checks hormones before and after to decide what replacement is needed.	Guide sourcesClinical context
Brain-fluid (CSF) leak from the nose	Median about 4.5% in one systematic review (IQR 2.6–10.2%); reported study ranges about 1.4–16.9%	May need a repair procedure; a leak raises the risk of meningitis.	Complications of transsphenoidal surgery — review (PMC)pmc.ncbi.nlm.nih.govPublished figure
Death	Very rare; around 1% in one complications review, and lower in selected modern endoscopic adenoma series	Varies with the tumour and your health; this is delicate skull-base surgery done in specialist centres.	Complications of transsphenoidal surgery — review (PMC)pmc.ncbi.nlm.nih.govPublished figure

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery is usually quicker than open brain surgery because the operation is done through the nose, but tiredness is common for several weeks and your hormones need careful checking and sometimes replacement afterwards.

First few days (in hospital)

You are watched closely, with regular checks of hormones, fluid balance and vision. Your nose will feel blocked and may have packing or splints for a short time. Steroids are often given. Most people stay about three to five days.

First 1 to 2 weeks

Blood tests check your hormone levels, and you are reviewed by the team. Avoid blowing your nose hard, heavy lifting and straining, which can disturb healing. A blocked nose and reduced smell are common.

Weeks 4 to 8

Energy gradually returns and most people adopt a gentle lifestyle for this period. The team checks hormones and may adjust replacement tablets. Sense of smell often improves over this time.

From around 3 months

A scan is often done to see how much tumour was removed, and longer-term hormone and vision follow-up is arranged. Any further treatment, such as medicines or radiotherapy, is planned if needed.

What's normal — and not a worry

A blocked, crusty or runny nose and a reduced sense of smell for some weeks
Tiredness and reduced concentration for several weeks
Mild headache in the early period
Needing to take hormone tablets and have regular blood tests while levels are checked

Aftercare

Take any hormone tablets, especially steroids, exactly as prescribed and do not stop them suddenly — ask what to do if you become unwell.
Avoid blowing your nose hard, heavy lifting, bending and straining in the early weeks.
Use any nasal sprays or rinses as advised to help your nose heal.
Drink to thirst and tell the team if you are passing very large amounts of urine or are extremely thirsty.
Do not drive until your team confirms it is safe.
Attend all blood tests, vision checks and scans, as hormone levels can change over time.
Know who to contact urgently if clear fluid drips from your nose, or you develop a severe headache, fever or neck stiffness.

Before-surgery checklist

Hormone tablets (such as hydrocortisone) collected and clearly understood
Written advice on steroid 'sick day' rules and an emergency contact number
Follow-up blood test, vision check and scan appointments noted
Help at home and time off work arranged (about 4 to 8 weeks)
Transport sorted, knowing you may not be able to drive
Nasal sprays or rinses ready if recommended
Questions written down for your endocrine and surgical follow-up

Scars and how they heal

Because the operation is usually done through the nose, there is no cut on the head and no shaved hair. There may be some soreness, crusting and a blocked nose inside while it heals. If a small graft is taken (for example from the nose, thigh or tummy) to seal the area, there can be a small scar there.

⚠ Get urgent help if…

Clear, watery fluid dripping from your nose, especially when you lean forward (possible brain-fluid leak)
A severe or worsening headache, neck stiffness or sensitivity to light, with or without fever (possible meningitis)
Any change in or loss of vision, or new double vision
Passing very large amounts of urine with extreme thirst (possible diabetes insipidus)
Feeling very unwell, dizzy, weak or faint (possible low steroid levels)
A heavy nosebleed that does not settle
A high temperature or feeling generally very unwell

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result usually means the tumour has been removed or reduced safely, pressure on the eyes has been relieved, and — for hormone-producing tumours — hormone levels are better controlled. The laboratory analysis of the tissue gives an exact diagnosis, and follow-up blood tests show how well the gland is working. Vision is checked to see whether it has improved.

Surgery cannot always remove the whole tumour, and it cannot guarantee that hormone levels return to normal or that vision fully recovers. Some people need long-term hormone replacement, and some need further treatment such as medicines or radiotherapy. The full picture is clearer once the pathology, hormone results and follow-up scan are available.

How long it lasts

Many pituitary tumours do not come back after successful surgery, but some can regrow over months or years, which is why follow-up scans and hormone checks continue long term. Some people need ongoing hormone replacement for life if the gland's function does not fully recover. Your team will explain the likely outlook for your specific tumour type and how you will be monitored.

Combining with other procedures

Pituitary tumour surgery is usually one part of a wider plan managed by a specialist team. Depending on the tumour, it may be combined with medicines (for example to control a hormone, or to replace one that is low), and sometimes with radiotherapy if tumour remains or regrows. An endocrinologist usually manages your hormones alongside the surgical team.

Follow-up & long-term care

You will be followed up by both a surgical and an endocrine (hormone) team, with blood tests in the first weeks, a vision check, and usually a scan at around three months and beyond. Hormone replacement is adjusted as needed. Any warning signs — especially a clear fluid leak from the nose, a severe headache with neck stiffness, vision change, or feeling very unwell — should prompt urgent contact rather than waiting for an appointment.

Take hormone replacement (such as steroids) exactly as prescribed and follow 'sick day' rules.
Attend regular blood tests and hormone reviews, as levels can change over time.
Attend follow-up scans to check for any regrowth of the tumour.
Have your vision checked as advised.
Report new symptoms — such as returning headaches, vision change or extreme thirst — early.

Revision and secondary surgery reality

Not all of a tumour can always be removed, so medicines or radiotherapy may be needed for the rest.
A brain-fluid leak can occasionally need a further procedure to repair it.
Monitoring scans may show regrowth, which can mean more surgery, radiotherapy or medicines over time.
Hormone replacement may need adjusting over the years as the gland's function changes.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

Joint follow-up by a surgical and endocrine (hormone) team, with clear hormone-monitoring and replacement plans.
Written warning signs for fluid leak, meningitis, vision change and low steroid levels, with an urgent contact route.
Steroid 'sick day' rules explained, and an emergency steroid plan if needed.
Vision testing before and after, and follow-up scans to check for regrowth.
Clear advice on nasal care, lifting, straining and return to driving and work.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

Pituitary surgery is usually an NHS service, so private cost questions arise rarely
Where private care applies: the neurosurgeon's, ENT surgeon's and anaesthetist's fees
The complexity of the tumour and whether an endoscopic or open approach is used
Hospital stay, including any high-dependency care
Imaging, computer guidance and laboratory (pathology) analysis
Endocrine (hormone) testing and ongoing hormone replacement
Vision testing and any further treatment such as radiotherapy

Make sure your written quote includes

The named neurosurgeon's (and ENT surgeon's) fee and the anaesthetist's fee
The hospital fee, including any high-dependency stay
Imaging, hormone testing and laboratory (pathology) costs
Endocrine follow-up and any hormone replacement included
Vision testing and follow-up scans
What happens, and who pays, if a complication such as a fluid leak occurs
Cancellation and rescheduling terms

On the NHS? Pituitary tumour surgery is usually carried out on the NHS in specialist pituitary centres with a joint surgical and endocrine team; private care is uncommon, though people may seek a private second opinion.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

What type of pituitary tumour do I have, and could it be treated with medicines or monitoring instead of surgery?
Is the aim to remove all of it, and how likely is that given its size and position?
What are my specific risks to vision, hormones and the brain-fluid lining?
Will an endocrinologist manage my hormones before and after surgery?
What hormone tablets might I need afterwards, and for how long?
How will I be followed up, and what would happen if the tumour regrows?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Will I have a scar or shaved head?

Usually not — the operation is most often done through the nose, so there is no cut on the head and no shaved hair. Your nose will feel blocked and sore for a while. Occasionally a larger tumour needs an approach through the skull instead.

Will I need to take hormones afterwards?

Many people need hormone tablets, at least for a time, because the pituitary controls several hormones. Some need long-term replacement. An endocrinologist checks your levels before and after surgery and adjusts treatment.

Is it done on the NHS or privately?

Pituitary surgery is usually carried out on the NHS in specialist pituitary centres with an endocrine team. Private care is uncommon; people sometimes seek a private second opinion about their diagnosis or options.

Could my tumour be treated without surgery?

Sometimes. Some hormone-producing tumours, especially prolactinomas, are usually treated with medicines first, and some small tumours are monitored with scans. A specialist team should explain whether surgery is the right step for you.

What is diabetes insipidus, which I have read about after this surgery?

It is a temporary, and occasionally lasting, problem where the body passes large amounts of urine and you feel very thirsty, because of an effect on a hormone that controls water. It is usually monitored closely after surgery and can be treated with medicine if needed.

Will surgery fix my vision?

If the tumour was pressing on the nerves to the eyes, surgery can relieve that pressure and vision often improves, but this is not guaranteed and depends on how long and how much the nerves were affected. Your vision is checked before and after.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS (UCLH) — Endoscopic transsphenoidal pituitary surgery NHS (Hull University Teaching Hospitals) — Pituitary surgery NICE CKS — Pituitary disorders Permanent diabetes insipidus after transsphenoidal surgery — systematic review (PMC) Complications of transsphenoidal surgery — review (PMC) Preoperative risk factors for complications in endoscopic pituitary surgery — systematic review

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.