Pituitary adenoma

Introduction
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Pituitary adenomas represent 10% to 15% of intracranial neoplasms. Typical presenting manifestations include amenorrhea, infertility, visual field abnormalities, and headache. Diagnosis is often made with brain MRI, visual field testing, and serum hormone assay. Prolactinoma, the most common type of pituitary adenoma, usually responds to therapy with a dopamine agonist such as bromocriptine or cabergoline. Rare refractory cases, large tumors, and pituitary adenomas that secrete other hormones are often treated with transsphenoidal surgical resection. Radiation therapy is reserved for tumors that cannot be completely resected. In this clinical article, Drs. Jai Grewal, Lee Tessler, and Santosh Kesari discuss new treatments for pituitary adenomas, including the emerging use of temozolomide chemotherapy.

Key points

  • Pituitary adenomas represent 10% to 15% of intracranial neoplasms.
  • Typical presenting manifestations include amenorrhea, infertility, visual field abnormalities, and headache.
  • Diagnosis is often made with brain MRI, visual field testing, and serum hormone assay.
  • Prolactinoma, the most common type of pituitary adenoma, usually responds to therapy with a dopamine agonist such as bromocriptine or cabergoline.
  • Rare refractory cases, large tumors, and pituitary adenomas that secrete other hormones are often treated with transsphenoidal surgical resection.
  • Radiation therapy is reserved for tumors that cannot be completely resected.
  • Temozolomide is emerging as a therapeutic option for patients with pituitary adenoma.
  • Radiosurgery to this area includes the significant risk of pituitary axis dysfunction.