Diagnosis and management of pituitary neuroendocrine tumors: recent advances

Pituitary neuroendocrine tumors (PitNETs) are a heterogeneous group of neoplasms originating from anterior pituitary cells, encompassing a spectrum from indolent microadenomas to highly invasive, aggressive tumors. Their clinical presentation varies from classic endocrine hyper- or hyposecretory syndromes to mass effect symptoms or incidental imaging findings. The 2022 World Health Organization classification has redefined PitNETs, emphasizing their neuroendocrine nature and the central role of transcription factor-based immunohistochemistry. Recent years have witnessed rapid progress in molecular characterization, multiomics, radiomics, and theragnostic approaches, which are reshaping the approach to these tumors regarding their diagnosis, risk stratification, and management. This review provides a comprehensive and practical synthesis of current evidence, focusing on the integration of biomarkers, advanced imaging, and personalized therapies that could be useful in clinical practice, and discusses future directions in precision management of PitNETs.