Pituitary Microadenomas Treatment & Management

Updated: Mar 23, 2018
  • Author: Bernard Corenblum, MD, FRCPC; Chief Editor: George T Griffing, MD  more...
  • Print
Treatment

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. [18, 1]

Next:

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.

A study by Mattogno et al indicated that in the treatment of pituitary microadenomas, the microsurgical sublabial approach is more effective than the endoscopic endonasal technique. [19]

A study by Fraioli et al found that in patients with prolactin-secreting microadenomas who, following dopamine agonist treatment, underwent transsphenoidal surgery, better postoperative results were achieved in patients who had been on dopamine agonist therapy for less than a year than in those who had been treated with a dopamine agonist for over a year. The former group had a hormonal remission rate of 84%, with the overall rate of prolactinemia improvement with no need for medical treatment reaching 92%. In the group treated for more than a year, the hormonal remission rate was 33.3%, with the overall rate of prolactinemia improvement with the possibility of medical treatment discontinuation reaching 49.9%. [20]

A retrospective study by Shirvani et al indicated that in patients with Cushing disease undergoing transsphenoidal surgery, remission is influenced by tumor size and consistency and by cavernous sinus extension. Among the 96 patients in the study (mean follow-up 44 mo), early remission occurred in 94.8%, with 68.8% of the study’s patients having microadenomas. Lower remission rates were found in cases of macroadenomas, cavernous sinus invasion, and harder tumor consistency. [21]

Nonsecreting pituitary microadenomas do not need to be surgically resected. [22]

Previous
Next:

Consultations

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

Previous
Next:

Diet

No specific diet is necessary.

Previous
Next:

Activity

No restriction of activity is necessary.

Previous