Diagnosis and treatment of pituitary tumors

Treatment of pituitary adenomas remains an interdisciplinary challenge involving neurosurgeons, endocrinologists and radiation oncologists. The different disciplines inaugurated advanced techniques to improve the already relatively high standard of outcome for the benefit of patients, covering molecular pathogenesis, novel therapeutic strategies for the different adenoma subtypes, developments in perioperative magnetic resonance imaging and radiosurgical management of pituitary adenomas.

Despite the progress achieved in medical treatment of hormone-secreting pituitary adenomas throughout recent years, surgery remains the primary therapy of choice except for prolactinomas. Recent studies in molecular pathogenesis aiming to find novel therapy targets and reports on new pharmacological drugs effecting GH-secreting pituitary adenomas are reviewed (for example, lanreotide 60, SOM320 and pegvisomant). Advances in surgical treatment of pituitary macroadenomas are obtained by pre- and especially by intraoperative (high-field) MRI offering a higher rate of safe and complete tumor removal. Therapy pitfalls mentioned in the literature throughout the last year as well as key points in the management of pituitary adenomas with focus on acromegaly and Cushing's disease are reported. Adjuvant irradiation for recurrent or residual adenomas is often a necessity. In comparison to standard conventional radiation strategies an increasing number of radiation oncologists and neurosurgeons report their experience with radiosurgery especially for smaller tumor remnants in pituitary adenomas.

Recent molecular studies suggest a new level of complexity in the tumorigenisis of pituitary adenomas in terms of possible cell-type-specific molecular changes. Except for prolactinomas surgery remains the primary treatment for pituitary adenomas. New pharmacological drugs achieve very encouraging endocrine results although no long-term follow-up is available so far. The results of trans-sphenoidal surgery will further improve by modern imaging techniques, especially by applying intraoperative high-field magnetic resonance imaging and neuronavigation. The results of radiosurgical techniques with regard to tumor control are mostly convincing, but definitive conclusions on long-term recurrence and/or late complications are not reliable so far.