[Non-functioning pituitary tumors - short presentation of the first German guideline]

Pituitary tumors are frequent (estimated prevalence in adults up to 10 %). However, diagnostic work-up and therapeutic concepts are not well standardized; especially for non-functioning tumors. In the beginning of 2020, the first German interdisciplinary guideline on these topics was published. Here, we present shortly the most important aspects of this guideline. One key message is that all patients with pituitary tumors should be managed by an interdisciplinary team (consisting at least of an endocrinologist, a neurosurgeon, and a (neuro-)radiologist). At first presentation, detailed morphological characterization (with magnet resonance imaging) and endocrine work-up to exclude (or prove) hormonal excess or deficiency states is required. An ophthalmological examination is needed only in presence of symptoms or large tumors affecting the visual system. In asymptomatic, hormonally inactive tumors a 'wait and scan' strategy is standard of care. In case of an (impending) visual impairment, surgical treatment shall be performed by an experienced pituitary surgeon. If the surgical resection was incomplete or if tumors are recurrent, therapeutic modalities (e. g. re-operation, radiotherapy, observation) should be interdisciplinary considered. In all patients with or without therapeutic intervention, long-term follow-up is required. Patient with larger pituitary tumors or former surgery/radiotherapy should be regularly counseled regarding potential symptoms of hormonal insufficiency.