Pituitary adenomas, recently renamed pituitary neuroendocrine tumors (PiNETs) according the new World Health Organization classification published in 2017, are one of the two most common intracranial tumors, with an estimated prevalence of 1 in 1,100 people.
A meticulous endocrine evaluation is the first therapeutic step in their management, aimed at detecting hormonal hypersecretion and anterior hypopituitarism. High-resolution magnetic resonance imaging (MRI) of the pituitary region using a dedicated protocol is then recommended to precisely localize the tumor and determine its extra-sellar extension. Each case is discussed weekly at our multidisciplinary meeting to determine the best therapeutic option for each individual patient.
The first-line treatment is usually transnasal transsphenoidal surgery, except for microprolactinomas that are effectively managed using dopamine agonist medication like cabergoline to control the endocrinopathy. Surgical resection in expert centers allows for elevated levels of hypersecreted hormone to be normalized in 50 to 90% of cases. In the event of failure or recurrence, a second surgery or radiotherapy can be proposed. Some PiNETs, including non-functional microadenomas, only require serial MRI monitoring without treatment.
Keywords
Pituitary adenoma, pituitary neuroendocrine tumor, prolactinoma, transsphenoidal surgery, acromegaly, Cushing’s disease