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REVIEW

Management of Pituitary Tumors

Ilan Shimon, MD, and Shlomo Melmed, MD

15 September 1998 | Volume 129 Issue 6 | Pages 472-483

Management of pituitary tumors has improved in the past decade since the introduction of novel therapeutic agents.As a result, several treatment options are now available. Dopamine agonists are the preferred treatment for both symptomatic microprolactinomas and macroprolactinomas; these drugs result in normalization of hormone levels and tumor shrinkage 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 hormone (TSH)-secreting, and nonfunctional adenomas, surgery often results in cure. Octreotide and the long-acting, slow-release somatostatin analogues are effective medical alternatives to or adjuvants for transsphenoidal surgery in patients with growth hormone-secreting and TSH-secreting tumors. No drug treatment is available for symptomatic nonfunctional tumors, and patients with ACTH-secreting adenomas may benefit from cortisol-lowering drugs after surgical failure. Pituitary irradiation may be required after surgery for ACTH-secreting, TSH-secreting, and 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 introduced for the management of pituitary tumors, more patients with hormone-secreting adenomas are being successfully treated medically.

Author and Article Information

From Cedars Sinai Research Institute, University of California, Los Angeles, School of Medicine, Los Angeles, California.
Acknowledgments: By National Institutes of Health grant DK-50238 (Dr. Melmed), the Doris Factor Molecular Endocrinology Laboratory, and the American Physicians Fellowship.
Requests for Reprints: Shlomo Melmed, MD, Cedars-Sinai Research Institute, University of California, Los Angeles, School of Medicine, Room 2015, 8700 Beverly Boulevard, Los Angeles, CA 90048.
Current Author Addresses: Dr. Shimon: Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer 52621, Israel.

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