Treatment Option Overview
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. 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. In a series of 32 patients, only 2 (6.2%) with gross total tumor removal and no postoperative radiation therapy showed radiological recurrence of the tumor at a mean follow-up of 5.5 years. Radiation therapy has been administered routinely in the postoperative period and after clear radiologic evidence of residual or recurrent tumor has been demonstrated; drug therapy appears to be of limited value.
Transsphenoidal surgery is the treatment of choice for patients with thyrotroph adenomas. Adjuvant radiation therapy may be employed when surgery is known to be noncurative even if the patient is still euthyroid because relapse is inevitable, and the full effect of radiation requires months or years. Medical therapy may be required for patients who are still hyperthyroid despite surgery and external radiation. Somatostatin analogues are the drugs of choice for treatment; however, the efficacy of treatment may wane with time.[6,20,21,22]
The initial treatment of patients with gonadotroph adenomas is usually by transsphenoidal surgery, particularly if the adenoma presents with neurological symptoms, because the effect of radiation therapy occurs too slowly, and no reliable medical therapy exists.
Treatment options for patients with pituitary carcinomas include resection and dopamine agonists for prolactin (PRL)-producing tumors; somatostatin analogues for GH-producing and thyroid-stimulating hormone (TSH)-producing tumors; radiation therapy, and chemotherapy. These treatments are palliative with the mean survival time ranging from 2 years to 2.4 years, though several case reports of long-term survivors have been published.[2,25,26,27]
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