The selection of treatment for patients with nonfunctioning (endocrine-inactive) tumors will depend on tumor size, the progressive course of the disease, and anatomical structures affected by the tumor extension. The majority of patients present with suprasellar extension and visual field deficits. In addition, many have hormone deficits prior to treatment. Surgical management is typically considered the first choice of treatment for patients with endocrine inactive pituitary adenomas because of its effectiveness in ameliorating symptoms of chiasmal compression and headache.[1] Radical removal of the tumor, however, is difficult to obtain because of the frequent invasiveness into the cavernous sinus. Seventy percent to 80% of patients experience normalization or improvement of visual field defects, and almost 100% of patients with headache as a presenting symptom experience relief. Regrowth of the tumor after radiologically confirmed gross total removal appears to be uncommon. Radiation therapy has been administered routinely in the postoperative period and after clear radiological evidence of residual or recurrent tumor has been demonstrated; drug therapy appears to be of limited value.[1,2,3]

STANDARD TREATMENT OPTIONS: [1,2,3]

1. Surgery (preferably with a transsphenoidal approach) followed by close observation with radiation therapy reserved for recurrence.
2. Radiation therapy.
3. Surgery and postoperative radiation therapy.

References:

1. Losa M, Mortini P, Barzaghi R, et al.: Endocrine inactive and gonadotroph adenomas: diagnosis and management. J Neurooncol 54 (2): 167-77, 2001.
2. Tsang RW, Brierley JD, Panzarella T, et al.: Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys 30 (3): 557-65, 1994.
3. Yeh PJ, Chen JW: Pituitary tumors: surgical and medical management. Surg Oncol 6 (2): 67-92, 1997.