Giant pituitary adenomas

Out of a series of 515 pituitary adenomas 77 giant tumours seen between 1953 and 1983 were selected and the current problems of their management discussed. Since CT became available the incidence of discovery of giant pituitary adenoma became higher at 20% against 11%, especially in elderly patients. The extent and the form of giant adenomas and the different types of expanding and invasive adenomas are described in detail. A large group--most invasive adenomas of younger aged patients comprises mostly giant prolactinomas. A second large group of expansive endocrine inactive group seems to be characteristic for older age groups. Previously reported extremely high mortality can be lowered thanks to microsurgery and in our experience also due to the use of CUSA and Laser. In this series mortality dropped from 30% to 10%, and even to 6% in the last five years. However the morbidity rate, even if transient, remained high. Operative approaches, according to site and extent are discussed. The preoperative therapy with Dopamine-agonists in form of depot-injection, may open up a new possibility of lowering the operative risk in giant prolactinomas, by reducing the tumour size and signs.