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Abstract:
Pituitary tumors are common in the general population. Since
neuroimaging techniques have improved, pituitary tumors are more often
diagnosed incidentally. About 16.7% of the general population show
changes in the pituitary gland. Predominantly, pituitary tumors are
benign pituitary adenomas. Pituitary carcinomas or aggressive pituitary
tumors are extremely rare. They might develop from benign adenomas. New
genetic and epigenetic abnormalities help us to understand pituitary
tumorigenesis and might lead to therapeutical targeting drugs in the
future. Macroadenomas (>1 cm) can lead to visual field disturbances,
compression of cranial nerves, hypopituitarism, and infiltration of the
cavernous sinuses. The functional status of the pituitary tumor is
important. About half to one third of all pituitary tumors are
non-functioning pituitary adenomas. The other pituitary tumors show a
specific pattern of hormone secretion. About 25% to 41% of all pituitary
tumors are prolactinomas, acromegaly with production of growth hormone
represents 10% to 15% of adenomas, Cushing's disease with production of
adrenocorticotropic hormone accounts for 10%, and other hormonal
characteristics are less common. Transsphenoidal resection and total
adenomectomy are desirable. Radiosurgery has enriched the surgical
treatment options. Surgical treatment is the intervention of choice
except for prolactinomas, where pharmaceutical treatment is recommended.
Pharmaceutical treatment consists of dopamine agonists such as
cabergoline and somatostatin analogues that include octreotide and
pasireotide; retinoic acid is of theoretical interest while peroxisome
proliferator-activated receptor-gamma-ligands are not clinically useful.
In acromegaly, pegvisomant is a further treatment option. Temozolomide
should be considered in aggressive pituitary tumors. In general,
pharmaceutical options developed recently have extended the repertoire
of treatment possibilities of pituitary tumors.
