Diagnosis and Treatment of Pituitary Adenomas

Abstract

Pituitary adenomas are among the most common primary intracranial tumours. They are predominantly benign and account for 10–15 % of all intracranial neoplasms. These tumours are divided into two subgroups: macroadenomas (> 1 cm) and microadenomas (<1 cm). About 30% of pituitary adenomas do not produce hormones. In other cases tumours can produce any of the hormones of the anterior pituitary gland and thus cause endocrine disorders. Compression of the pituitary gland, adjacent cranial nerves and brain structures can lead to gland failure, cranial nerve deficit and other neurological disorders. Visual impairment, usually with bitemporal hemianopia, is one of the most common primary symptoms. Diagnosis of the disease requires an interdisciplinary approach. Transnasal transsphenoidal resection is indicated for all patients with symptomatic pituitary adenomas except prolactinomas. Prolactinomas respond very well to treatment with dopamine agonists. In cases of pituitary insufficiency a timely start of adequate hormone replacement therapy is important. Long-term follow-up is an integral part of the treatment concept. In this review we examine the current diagnostic criteria and treatment methods for various forms of pituitary adenomas.