Pituitary tumors
Journal
Current Treatment Options in Neurology
Publisher
Current Medicine Group LLC
ISSN
1092-8480 (Print) 1534-3138 (Online)
Issue
Volume 11, Number 4 / July, 2009
DOI
10.1007/s11940-009-0032-6
Pages
287-296
Subject Collection
Medicine
SpringerLink Date
Saturday, May 30, 2009
PDF (324.5 KB)Nestoras Mathioudakis and Roberto Salvatori1
(1)
Johns Hopkins School of Endocrinology and Metabolism, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA
Published online: 31 May 2009
Opinion statement Pituitary adenomas are the most common intrasellar tumors. With the exception of prolactinomas, first-line treatment is almost always surgical. Prolactinomas are usually treated with dopamine agonists such as cabergoline or bromocriptine. Somatostatin analogues, such as octreotide and lanreotide, can be adjunctive to surgical therapy in acromegaly, although they can be used as primary therapy in selected cases. Pegvisomant, a growth hormone receptor antagonist, is reserved for acromegalic patients who are resistant to treatment with somatostatin analogues. No effective medical therapy is available for adenomas that secrete adrenocorticotropic hormone, and occasionally bilateral adrenalectomy is required to resolve severe hypercortisolemia. Radiation therapy (fractionated or radiosurgery) can be used for residual or recurrent pituitary tumors. Asymptomatic, nonfunctioning pituitary adenomas may be followed without any intervention, but surgery is typically indicated if there are symptoms of mass effect on the optic chiasm or endocrine dysfunction. In the hands of an experienced pituitary neurosurgeon, the prognosis for endocrinologic recovery and visual improvement is good.
Roberto Salvatori
Email: salvator@jhmi.edu
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