The pituitary gland is a small, pea-sized endocrine organ situated at the base of the brain, directly below the hypothalamus and behind the bridge of the nose. Despite its size, it plays a significant role in regulating many of the body’s hormones — including those that control growth, metabolism, stress response, and reproductive function.
Tumours in this region are often benign, but they can still cause meaningful symptoms. These may arise from hormonal imbalance, or from pressure on nearby structures — particularly the optic nerves, which sit close to the pituitary gland and may be affected as a tumour grows.
When surgery is indicated, a technique commonly used is endoscopic transsphenoidal surgery, a minimally invasive approach that allows access to the tumour through the nose, without the need for external incisions or opening the skull.
What Is Endoscopic Transsphenoidal Surgery?
The procedure uses a small camera (endoscope) inserted through the nasal passages and sphenoid sinus — a naturally occurring air-filled cavity behind the nose — to reach the pituitary gland at the skull base. This anatomical corridor allows the surgical team to access most pituitary tumours directly, without disturbing surrounding brain tissue.
The endoscope provides magnified, high-definition visualisation of the surgical field, including tumour margins, surrounding blood vessels, and structures such as the optic nerves.
This procedure is typically performed as a collaborative surgery between a neurosurgeon and an ENT (ear, nose, and throat) surgeon. The ENT surgeon manages the nasal and sinus portion of the approach, creating a safe pathway to the tumour. The neurosurgeon then proceeds with tumour removal. This team-based approach is designed to optimise both surgical precision and patient safety.
Pre-Operative Evaluation
Before surgery is scheduled, your medical team will conduct a comprehensive assessment to understand the tumour’s size, location, hormonal activity, and relationship to surrounding structures.
Imaging
An MRI with contrast is the primary imaging study used. It provides detailed views of the pituitary gland and tumour, including whether the tumour extends toward the cavernous sinuses (which contain the carotid arteries) or compresses the optic chiasm above. A CT scan may complement the MRI, particularly for assessing bone anatomy of the skull base and planning the surgical approach.
Hormonal Assessment
Blood tests measure the levels of all relevant pituitary hormones. Hormone-secreting tumours may require specific pre-operative management — for example, certain medications to help control elevated cortisol or growth hormone levels before surgery. Your endocrinologist and neurosurgeon will guide this process.
Visual Field Testing
Formal visual field testing (perimetry) documents any vision loss that may have resulted from optic nerve compression. This baseline allows the team to monitor for visual improvement following surgery. Many patients with visual field changes notice improvement in the weeks after successful tumour decompression, though individual outcomes vary.
Nasal and Sinus Assessment
An ENT specialist will examine your nasal passages and sinus anatomy. Factors such as previous sinus surgery, a deviated septum, or active sinus infection may influence surgical planning. Active infections are typically treated before proceeding.
The Surgical Procedure
The operation is performed under general anaesthesia. Duration varies with tumour size and complexity, typically ranging from two to four hours.
The endoscope is introduced through one or both nostrils, and the surgical team works through the sphenoid sinus to expose the base of the skull and, subsequently, the pituitary gland. Once the tumour is reached, it is carefully removed using specialised instruments, with the endoscope providing a magnified view to help distinguish tumour from healthy pituitary tissue.
Image guidance technology may be used to overlay pre-operative MRI data onto the surgical field, confirming instrument position throughout the procedure.
After tumour removal, the surgical team reconstructs the skull base to reduce the risk of cerebrospinal fluid (CSF) leakage. This typically involves layers of tissue grafts and/or biological sealant materials.
Because all access is through the nostrils, no external incisions are made and no visible scars result from the surgery.
After Surgery: What to Expect in Hospital
Following surgery, patients are closely monitored in a neurosurgical ward. Key areas of observation include:
- Vision — any changes from baseline are assessed promptly
- Hormone levels — including monitoring for conditions such as diabetes insipidus (a temporary disruption to fluid balance that may occur when the pituitary gland is disturbed)
- Fluid balance and sodium levels — checked regularly via blood tests, as the pituitary gland plays a role in regulating these
If pre-operative testing identified hormone deficiencies, or if surgery affects normal pituitary tissue, hormone replacement therapy may be started during the admission. This is closely guided by your medical team.
In private hospitals in Singapore, the typical hospital stay is approximately 2–4 days, depending on recovery progress and any hormonal adjustments required.
Home Recovery
Recovery is generally gradual, and individual experiences vary.
In the first 1–2 weeks, most patients rest at home and limit activity. Fatigue is common and may be more pronounced than expected. Nasal symptoms — such as mild congestion, crusting, or a blocked feeling — are normal in the early weeks and typically improve with time. Saline nasal spray is usually recommended to keep nasal passages moist.
Within 2–4 weeks, many patients feel well enough to resume light daily activities, including desk-based work. Specific timelines depend on the individual and the nature of the procedure.
For at least 4–6 weeks, the following are typically avoided to allow proper healing:
- Nose blowing or straining
- Heavy lifting
- Swimming
- Air travel (pressure changes can affect the healing skull base)
- Strenuous exercise
Your surgeon will advise on when each activity may be safely resumed based on your recovery.
Follow-Up and Long-Term Care
Follow-up is an important part of pituitary tumour care, and monitoring continues well beyond surgery.
Most patients are reviewed within 1–2 weeks after discharge. A follow-up MRI is typically arranged at around 3 months post-surgery to establish a post-operative baseline. Subsequent imaging is scheduled based on the type of tumour, the completeness of removal, and your individual clinical picture.
Pituitary hormone levels are assessed at regular intervals. Some patients require permanent hormone replacement for one or more pituitary functions; others recover full hormone production over months. Your endocrinologist will adjust any replacement therapy based on symptoms and blood test results.
For hormone-secreting tumours, the success of surgery is measured by the normalisation of hormone levels — for example, resolution of elevated growth hormone in acromegaly, or cortisol normalisation in Cushing’s disease. These changes may take days to weeks to become apparent depending on the hormone involved.
In some cases, additional treatment — such as medication or radiotherapy — may be recommended depending on the tumour type, its behaviour, and the extent of removal. Long-term management is often coordinated with an endocrinologist to support optimal hormonal balance and overall health.
Potential Complications
While endoscopic transsphenoidal surgery is generally considered safe, as with all surgical procedures there are potential risks that your surgeon will discuss with you in detail.
CSF Leak — Cerebrospinal fluid leakage may occur in a small number of cases, particularly with larger tumours. Many leaks resolve with conservative measures such as bed rest and avoiding straining. Persistent leaks may require additional surgical repair. If you notice clear, watery fluid draining from your nose after surgery, contact your surgical team promptly.
Diabetes Insipidus — Temporary disruption of antidiuretic hormone (ADH) production may cause frequent urination and increased thirst. This is managed with medication and typically resolves within days to weeks. A small number of patients may require longer-term management.
Hormone Deficiency — Surgery may affect normal pituitary tissue, causing new or worsening hormone deficiencies. Cortisol and thyroid hormone are most commonly affected. Hormone replacement therapy manages deficiencies effectively.
Residual Tumour — Complete removal is not always possible, particularly when tumours extend into the cavernous sinuses or closely involve blood vessels. Residual tumour may be monitored with imaging, treated with radiation, or managed with medication, depending on the specific situation.
Your surgeon will explain these risks in full during your pre-operative consultation, including how they relate to your individual circumstances.
When to Seek Immediate Medical Attention
Contact your surgical team promptly if you experience:
- Clear, watery fluid draining from your nose
- Severe headache not relieved by prescribed medication
- Fever above 38°C
- New or worsening vision changes
- Excessive thirst with markedly increased urination
- Nausea or vomiting preventing you from taking medications
- Unusual confusion or drowsiness
Commonly Asked Questions
Will I have any visible scars?
No. All surgical access is through the nostrils, so there are no external incisions and no visible scarring.
When can I return to work?
Most patients with desk-based jobs are able to return within 2–4 weeks. Those in physically demanding roles typically require 4–6 weeks off, or longer. Your surgeon will advise based on your specific procedure and job requirements.
Will I need hormone replacement permanently?
This depends on tumour size, how much normal pituitary tissue was involved, and your pre-operative hormone function. Some patients require no ongoing replacement; others may need one or more hormones lifelong. Hormone status is reassessed over the first year and beyond.
Is the tumour likely to come back?
This varies by tumour type and how completely it was removed. Tumours with complete removal generally have lower recurrence rates; those with incomplete removal or certain biological characteristics may have a higher likelihood. Regular imaging surveillance is designed to detect any changes early.
What if surgery doesn’t fully remove the tumour?
If the tumour cannot be fully removed — for example, because it involves the cavernous sinus — additional treatment options may include medication, radiotherapy, or a combination. Your team will discuss all options relevant to your situation.
This article is intended for general educational purposes and should not replace a personalised medical consultation. Please consult a qualified specialist for advice on your individual condition.
Next Steps
If you have been diagnosed with a pituitary tumour, or are experiencing symptoms such as unexplained vision changes, hormonal imbalance, or persistent headaches that may be related to a pituitary condition, a neurosurgeon can assess whether endoscopic transsphenoidal surgery is appropriate for your specific situation.
