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Pituitary Microadenomas Treatment & Management

  • Author: Bernard Corenblum, MD, FRCPC; Chief Editor: George T Griffing, MD  more...
 
Updated: Jul 25, 2016
 

Medical Care

For prolactinomas, therapy with a dopaminergic drug is the treatment of choice (see Hyperprolactinemia). The most common are bromocriptine and cabergoline. Cabergoline is the primary dopamine agonist used, or it is used if there is bromocriptine intolerance or resistance.

Acromegaly may be medically controlled with long-acting somatostatin analogues, dopamine agonists such as cabergoline, or growth hormone receptor antagonists. For microadenomas, medical therapy is an alternative to surgical resection.

Cushing syndrome is best treated with surgical resection of the microadenoma, if possible. Medical alternatives, especially after surgical failure, include a new long-acting somatostatin agonist pasireotide, a glucocorticoid receptor antagonist mifepristone, or adrenal steroidogenesis inhibitors such as ketoconazole.

Nonsecreting microadenomas only need observation. Clinical observation may be routine or may only occur if new symptoms develop. Whether serial MRI scanning is needed is controversial, as few microadenomas enlarge and only rarely cause clinical symptoms. Some guidelines and expert opinion recommend no routine follow-up MRI scanning unless clinical symptoms occur, others suggest a repeat MRI after 1 year, and some recommend serial MRI scanning over many years. The best cost-effective approach is yet to be identified.[8, 14]

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Surgical Care

For prolactin-secreting microadenomas, surgical removal is followed by recurrence in 10-50% of patients. Therefore, medical therapy is preferred.

Secretory tumors are best removed by the transsphenoidal approach.

Some centers have used gamma-knife radiation for recurrent tumors.

Nonsecreting pituitary microadenomas do not need to be surgically resected.[17]

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Consultations

Endocrinologic consultation is advisable if clinical evidence of hormone secretion or deficiency exists.

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Diet

No specific diet is necessary.

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Activity

No restriction of activity is necessary.

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Contributor Information and Disclosures
Author

Bernard Corenblum, MD, FRCPC Professor of Medicine, Director, Endocrine-Metabolic Testing and Treatment Unit, Ovulation Induction Program, Department of Internal Medicine, Division of Endocrinology, University of Calgary Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Acknowledgements

David M Klachko, MD, MEd Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Missouri-Columbia School of Medicine

David M Klachko, MD, MEd is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Missouri State Medical Association, Sigma Xi, and The Endocrine Society

Disclosure: Nothing to disclose.

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MRI showing a nonenhancing area in the pituitary consistent with a microadenoma in a patient with hyperprolactinemia.
 
 
 
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