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Updated: Jun 18, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Functional pituitary adenoma imaging
Linus Hesse1,2,3, Linus Haberbosch4,5,6
1Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Department of Endocrinology and Metabolism, European Reference Network On Rare Endocrine Diseases (ENDO-ERN), 10117, Berlin, Germany.
None:
High-resolution pituitary MRI localises most pituitary neuroendocrine tumours (PitNETs), yet clinically important subgroups remain challenging: (i) very small functioning tumours, particularly corticotroph microadenomas, and (ii) post-operative remnants where scar, gland and tumour cannot be reliably separated. Functional imaging, specifically PET has matured into a problem-solving modality when conventional imaging is equivocal, provided it is used selectively and interpreted within a physiology-led framework. This review proposes an MRI-first, tiered imaging strategy and a pragmatic approach to tracer selection from the available armamentarium ([11C]methionine, [68 Ga]SSTR ligands, [68 Ga]PentixaFor, [18F]FET and [18F]FDG). We emphasise how to optimise PET acquisition and reporting, and how to integrate imaging with endocrine phenotype, treatment history and surgical/radiosurgical planning to maximise clinical impact while safeguarding pituitary function.
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