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Review
. 2017 Jun 1;19(6):762-773.
doi: 10.1093/neuonc/now130.

Management of hormone-secreting pituitary adenomas

Gautam U Mehta  1 , Russell R Lonser  1   2
Affiliations
Review

Management of hormone-secreting pituitary adenomas

Gautam U Mehta et al. Neuro Oncol. .

Abstract

Pituitary adenomas are one of the most common primary central nervous system tumors and have an estimated prevalence of 17%. Approximately half of pituitary adenomas secrete distinct pituitary hormones (most often prolactin, growth hormone, or adrenocorticotropic hormone). While these tumors are histologically benign, they have potent endocrine effects that lead to significant morbidity and shortened lifespan. Because of their pathophysiologic endocrine secretion and anatomic location near critical neural/vascular structures, hormone-secreting pituitary adenomas require defined management paradigms that can include relief of mass effect and biochemical remission. Management of hormone-secreting pituitary adenomas involves a multidisciplinary approach that can incorporate surgical, medical, and/or radiation therapies. Early and effective treatment of hormone-secreting pituitary adenomas can reduce morbidity and mortality. Consequently, understanding clinical features as well as therapeutic options in the context of the specific biological features of each type of hormone-secreting pituitary adenoma is critical for optimal management.

Keywords: Cushing’s disease; acromegaly; management; pituitary adenoma; prolactinoma.

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Figures

Fig. 1
Fig. 1
Management paradigm for prolactinomas. Persistent disease or recurrent disease is characterized by hyperprolactinemia and/or adenoma growth.
Fig. 2
Fig. 2
Management paradigm for growth hormone-secreting pituitary adenomas. Persistent disease is characterized by lack of biochemical remission and/or adenoma growth. *Radiation therapy may be considered after failed transsphenoidal surgery (second-line) in the appropriately selected patient.
Fig. 3
Fig. 3
Management paradigm for Cushing disease. Persistent disease is characterized by hypercortisolemia (majority of cases) and/or adenoma growth. *In most cases, medical therapy should be initiated concurrently with radiation therapy to limit the morbidity of hypercortisolemia until biochemical remission is achieved.
See this image and copyright information in PMC

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