Pituitary Adenomas: What Are the Key Features? What Are the Current Treatments? Where Is the Future Taking Us?

World Neurosurg. 2019 Jul:127:695-709. doi: 10.1016/j.wneu.2019.03.049.

Abstract

Pituitary tumors are a heterogeneous group of lesions (usually benign) and proper understanding of the anatomy, physiology, and pathology of the hypothalamic/pituitary region is essential to make an accurate diagnosis and define the essential treatment options (i.e., surgery, medical therapies, and radiotherapy, alone or in combination). Surgery is the primary treatment for acromegaly, Cushing disease, thyroid-stimulating hormone-secreting adenomas, resistant prolactinomas, and nonfunctioning pituitary adenomas causing mass effect. Medical and radiation therapy are reserved in cases in which surgery is not possible or does not provide a complete cure. In the last decades, tremendous innovations (i.e., targeted drugs and refined surgical tools and techniques) have expanded the treatment strategies for pituitary adenomas. We herein report the current indications for and depiction of the surgical techniques in pituitary surgery, review current medical treatments, and provide a glimpse of future possibilities.

Keywords: Adenomas; Endocrinology; Endoscopic endonasal surgery; Multidisciplinary team; Pituitary/hypothalamus; Radiation oncology; Targeted drugs.

MeSH terms

  • ACTH-Secreting Pituitary Adenoma / pathology
  • ACTH-Secreting Pituitary Adenoma / therapy
  • Adenoma / pathology
  • Adenoma / therapy*
  • Adrenergic Antagonists / therapeutic use
  • Dopamine Agonists / therapeutic use
  • Drug Therapy, Combination
  • Forecasting
  • Growth Hormone-Secreting Pituitary Adenoma / pathology
  • Growth Hormone-Secreting Pituitary Adenoma / therapy
  • Humans
  • Nasal Surgical Procedures / methods
  • Neuroendoscopy / methods
  • Neuroendoscopy / trends
  • Pituitary Gland / surgery
  • Pituitary Neoplasms / pathology
  • Pituitary Neoplasms / therapy*
  • Postoperative Care
  • Prolactinoma / pathology
  • Prolactinoma / therapy
  • Radiosurgery / methods
  • Receptors, Glucocorticoid / antagonists & inhibitors
  • Steroid Synthesis Inhibitors / therapeutic use

Substances

  • Adrenergic Antagonists
  • Dopamine Agonists
  • Receptors, Glucocorticoid
  • Steroid Synthesis Inhibitors