Treatment Options for Nonfunctioning Pituitary Tumors

Treatment options for nonfunctioning pituitary tumors include:

Treatment selection for patients with nonfunctioning (endocrine-inactive) tumors depends on tumor size, the progressive course of the disease, and anatomical structures affected by the tumor extension. Most patients present with suprasellar extension and visual field deficits. In addition, many have hormone deficits before treatment. The initial treatment of patients with gonadotroph adenomas is usually by transsphenoidal surgery, particularly if the adenoma presents with neurological symptoms. This is because the effect of radiation therapy occurs too slowly, and no reliable medical therapy exists.[4]

The first choice of treatment for patients with endocrine-inactive pituitary adenomas is usually surgery, which ameliorates symptoms of chiasmal compression and headache.[1] However, radical removal of the tumor is difficult because of frequent invasion into the cavernous sinus. Seventy percent to 80% of patients experience normalization or improvement of visual field defects, and almost 100% of patients with headache as a presenting symptom experience relief. Regrowth of the tumor after radiologically confirmed gross total removal appears to be uncommon. In a series of 32 patients, only 2 (6.2%) with gross total tumor removal and no postoperative radiation therapy showed radiological recurrence of the tumor at a mean follow-up of 5.5 years.[5]

Radiation therapy has been given postoperatively, and after clear radiological evidence of residual or recurrent tumor has been demonstrated.[1-3] Drug therapy appears to be of limited value.[1-3]