MANAGEMENT OF PITUITARY-TUMORS

Management of pituitary tumors has improved in the past decade since t he introduction of novel therapeutic agents. As a result, several trea tment options are now available. Dopamine agonists are the preferred t reatment for both symptomatic microprolactinomas and macroprolactinoma s; these drugs result in normalization of hormone levels and tumor shr inkage 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 hor mone (TSH)-secreting, and nonfunctional adenomas, surgery often result s in cure. Octreotide and the long-acting, slow-release somatostatin a nalogues are effective medical alternatives to or adjuvants for transs phenoidal surgery in patients with growth hormone-secreting and TSH-se creting tumors. No drug treatment is available for symptomatic nonfunc tional tumors, and patients with ACTH-secreting adenomas may benefit f rom cortisol-lowering drugs after surgical failure. Pituitary irradiat ion may be required after surgery for ACTH-secreting, TSH-secreting, a nd 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 intr oduced for the management of pituitary tumors, more patients with horm one-secreting adenomas are being successfully treated medically.