Management

Treatment depends upon the age of the patient, the clinical presentation, and the nature of the tumour. Options are medical, surgical or radiotherapy.

Medical treatments:

• somatostatin analogues - inhibit growth hormone production. Also, may be effective against TSH adenomas.
• bromocriptine and cabergoline - these are dopamine agonists that lowers circulating hormone levels. Especially for prolactinomas.

Surgical approaches:

• trans-sphenoidal
• trans-ethmoidal
• transfrontal - for tumours with large frontal or lateral extensions. Necessitates a craniotomy flap.

Radiotherapy:

• pituitary adenomas are radiosensitive. External irradation is most often employed. Less commonly, radioactive seeds of gold are implanted into the pituitary fossa. Hormone levels fall after several months. Replacement hormone therapy is necessary in the long term (5-10 years) due to decline in pituitary function.

As a guide, large tumours usually require surgical decompression followed by radiotherapy and correction of underlying endocrine abnormalities with steroid cover prior to surgery. For small tumours treat the underlying hormonal disturbance.