What are the treatments for pituitary tumors? How to use medication for pituitary tumors

Pituitary tumor is one of the most common benign tumors in the brain, with an incidence rate of about 1/100,000 in the population, 28/1 million in males and 70/1 million in females. Pituitary tumors endanger human health mainly in the following aspects: ① Excessive secretion of pituitary hormones causes a series of metabolic disorders, such as amenorrhea and lactation; ② Tumor compression leads to low pituitary hormones, causing corresponding target gland dysfunction, such as infertility; ③ Compression of the sellar region structure, such as visual field impairment. Pituitary tumors are benign tumors, and good results can be achieved through standardized and reasonable treatment.

In the past, when people mentioned the treatment of pituitary tumors, their first impression was surgical resection, but this is a wrong view. To know the standard treatment plan for pituitary tumors, we must first talk about the pathological classification of pituitary tumors. Clinically speaking, pituitary tumors are generally divided into the following 8 types: prolactin adenoma, growth hormone adenoma, adrenocorticotropic hormone adenoma, thyrotropin adenoma, multi-secreting function adenoma, non-secreting function adenoma and malignant pituitary adenoma. Among them, only prolactin adenoma and growth hormone adenoma are effective in drug treatment, and prolactin adenoma is more effective. Therefore, after patients are found to have pituitary tumors, they must first determine the treatment plan based on the results of hormone tests.

(I) What drugs can be used for pituitary tumors?

1. Dopamine agonists: Bromocriptine and cabergoline are the representatives, of which bromocriptine is the first choice. It can normalize the growth hormone level in 20% of patients and reduce the tumor volume in 30% of patients.

2. Somatostatin drugs: such as octreotide, lanreotide, etc., can reduce the growth hormone levels in 71% of patients, restore the growth hormone levels to normal in 50% of patients, and reduce the tumor volume in 30% of patients.

3. Growth hormone receptor antagonist: Pegvisomant, treatment for more than 12 months can restore IGF-1 levels to normal in 97% of patients. However, the tumor volume does not change much. This drug needs to be injected subcutaneously.

(II) Usage of main drugs

1. Bromocriptine: Dosage: The initial dose of bromocriptine (2.5 mg/tablet) for treatment is 0.625-1.25 mg/d. It is recommended to be taken orally with a snack before going to bed at night. Increase by 1.25 mg every week until it reaches 2 tablets/d or 3 tablets/d. The adverse reactions of upper gastrointestinal discomfort and orthostatic hypotension can be reduced through a slow dosage increase plan and taking it with a snack before going to bed. 7.5 mg/d is an effective therapeutic dose. If the tumor volume and PRL control are not ideal, the dose can be gradually increased to 15 mg/d. Continuing to increase the dose will not further improve the treatment effect. Therefore, large doses above 15 mg are not recommended, but it is recommended to switch to cabergoline treatment.

2. Cabergoline: Dosage: The initial treatment dose of 0.5 mg/tablet is 0.25-0.5 mg per week, and the dose is increased by 0.25-0.5 mg per month until PRL is normal. It is rare that the dose exceeds 3 mg per week. Compared with bromocriptine, cabergoline is more convenient to take and has better patient tolerance. Patients who are resistant to bromocriptine can choose cabergoline for treatment.

3. Main side effects of drugs

The adverse reactions of bromocriptine include: headache, dizziness, nausea, vomiting, digestive tract symptoms such as peptic ulcer, nasal congestion, constipation, postural hypotension, and even shock in severe patients; fatigue, anxiety, depression, alcohol intolerance; drug-induced pituitary tumor stroke. The adverse reactions of cabergoline are the same as those of bromocriptine, and the gastrointestinal adverse reactions are milder than those of bromocriptine. Other adverse reactions include mental illness and potential valvular heart disease.

4. Pregnancy-related management of patients with prolactinoma

The basic principle is to limit the exposure of the fetus to the drug for as short a time as possible. Bromocriptine is relatively safe for the fetus. The incidence of spontaneous abortion, intrauterine fetal death, and fetal malformation in women with pituitary prolactin adenoma treated with bromocriptine is similar to that of obstetric abnormalities in normal women. The tumor of patients with prolactin microadenomas is less likely to grow after pregnancy, while the possibility of tumor growth in patients with macroadenomas is more than 25%.

Patients with microadenomas before pregnancy can become pregnant after prolactin levels drop to normal and regular menstruation resumes. However, due to the need to maintain luteal function, the drug should be discontinued after 12 weeks of pregnancy; for women with large adenomas who want to have children, pregnancy is allowed only after the adenoma is reduced by bromocriptine treatment. During pregnancy, it is recommended to take the drug throughout the course.

Normal people's PRL levels gradually increase after pregnancy, but the maximum does not exceed 300-400ug/L. Patients with pre-pregnancy pituitary prolactin adenoma should pay attention to clinical manifestations, such as visual field loss, headache, decreased vision, especially visual field loss or cavernous sinus syndrome. If tumor stroke occurs, bromocriptine should be added immediately. If there is no improvement within 1 week, surgical treatment should be considered and the pregnancy should be terminated as soon as possible (when the pregnancy is close to full term).

5. Medication during lactation for patients with pituitary prolactinoma

There is no evidence that breastfeeding stimulates tumor growth. For women who wish to breastfeed, unless pregnancy-induced tumor growth requires treatment, dopamine receptor agonists should generally be delayed until the patient wishes to stop breastfeeding.