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Management of Pituitary Tumors

Ilan Shimon, MD; and Shlomo Melmed, MD
[+] Article and Author Information

From Cedars Sinai Research Institute, University of California, Los Angeles, School of Medicine, Los Angeles, California. Acknowledgments: By National Institutes of Health grant DK-50238 (Dr. Melmed), the Doris Factor Molecular Endocrinology Laboratory, and the American Physicians Fellowship. Requests for Reprints: Shlomo Melmed, MD, Cedars-Sinai Research Institute, University of California, Los Angeles, School of Medicine, Room 2015, 8700 Beverly Boulevard, Los Angeles, CA 90048. Current Author Addresses: Dr. Shimon: Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer 52621, Israel.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(6):472-483. doi:10.7326/0003-4819-129-6-199809150-00009
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Management of pituitary tumors has improved in the past decade since the introduction of novel therapeutic agents.As a result, several treatment options are now available. Dopamine agonists are the preferred treatment for both symptomatic microprolactinomas and macroprolactinomas; these drugs result in normalization of hormone levels and tumor shrinkage in most treated patients. New formulations (such as cabergoline and parenteral bromocriptine) with prolonged duration of action offer improved compliance with treatment and cure rates. For acromegaly and adrenocorticotropin hormone (ACTH)-secreting, thyroid-stimulating hormone (TSH)-secreting, and nonfunctional adenomas, surgery often results in cure. Octreotide and the long-acting, slow-release somatostatin analogues are effective medical alternatives to or adjuvants for transsphenoidal surgery in patients with growth hormone-secreting and TSH-secreting tumors. No drug treatment is available for symptomatic nonfunctional tumors, and patients with ACTH-secreting adenomas may benefit from cortisol-lowering drugs after surgical failure. Pituitary irradiation may be required after surgery for ACTH-secreting, TSH-secreting, and nonfunctioning tumors; it is less commonly required for acromegaly. Although many pituitary tumors are successfully resected, functional adenomas may not be cured by surgery. As more-effective drugs are introduced for the management of pituitary tumors, more patients with hormone-secreting adenomas are being successfully treated medically.

Figures

Grahic Jump Location
Figure 1.
Proposed algorithm for treating patients with symptomatic prolactinomas.

MRI = magnetic resonance imaging.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Proposed algorithm for managing patients with somatotroph adenoma.

Treatment choice should be determined by evaluation of risks and benefits of surgery, irradiation, or somatostatin analogue for each individual patient. If growth hormone (GH) immunoradiometric assay is used, a growth hormone level less than 1 µg/L after glucose suppression is preferable. IGF-I = insulin-like growth factor-I; SRIF = somatotropin release-inhibiting factor.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Proposed algorithm for managing patients with adrenocorticotropin hormone (ACTH)-secreting pituitary adenomas.
Grahic Jump Location
Grahic Jump Location
Figure 4.
Proposed algorithm for managing patients with a nonfunctioning pituitary mass.

MRI = magnetic resonance imaging.

Grahic Jump Location

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