Pituitary adenomas are the most common intrasellar
tumors. With the exception of
prolactinomas, first-line treatment is almost always surgical.
Prolactinomas are usually treated with
dopamine agonists such as
cabergoline or
bromocriptine.
Somatostatin analogues, such as
octreotide and
lanreotide, can be adjunctive to surgical
therapy in
acromegaly, although they can be used as primary
therapy in selected cases.
Pegvisomant, a
growth hormone receptor antagonist, is reserved for acromegalic patients who are resistant to treatment with
somatostatin analogues. No effective medical
therapy is available for
adenomas that secrete
adrenocorticotropic hormone, and occasionally bilateral
adrenalectomy is required to resolve severe hypercortisolemia.
Radiation therapy (fractionated or radiosurgery) can be used for residual or recurrent
pituitary tumors. Asymptomatic, nonfunctioning
pituitary adenomas may be followed without any intervention, but surgery is typically indicated if there are symptoms of mass effect on the optic chiasm or endocrine dysfunction. In the hands of an experienced pituitary neurosurgeon, the prognosis for endocrinologic recovery and visual improvement is good.