PITUITARY-TUMORS - CURRENT CONCEPTS IN DIAGNOSIS AND MANAGEMENT

Diagnostic advances have resulted in earlier and more frequent recogni tion of pituitary tumors. Pituitary tumors cause problems owing to the hormones they secrete or the effects of an expanding sellar mass-hypo pituitarism, visual field abnormalities, and neurologic deficits. Prol actin-secreting tumors (prolactinomas), which cause amenorrhea, galact orrhea, and hypogonadism, constitute the most common type of primary p ituitary tumors, followed by growth hormone-secreting tumors, which ca use acromegaly, and corticotropin-secreting tumors, which cause Cushin g's syndrome. Hypersecretion of thyroid-stimulating hormone, the gonad otropins, or alpha-subunits is unusual. Nonfunctional tumors currently represent only 10% of all clinically diagnosed pituitary adenomas, an d some of these are alpha-subunit-secreting adenomas. Insights into th e pathogenesis and biologic behavior of these usually benign tumors ha ve been gained from genetic studies. We review some of the recent adva nces and salient features of the diagnosis and management of pituitary tumors, including biochemical and radiologic diagnosis, transsphenoid al surgery, radiation therapy, and medical therapy. Each type of lesio n requires a comprehensive but individualized treatment approach, and regardless of the mode of therapy, careful follow-up is essential.