Commonly used treatments for pituitary adenoma

Pituitary tumors are no longer unfamiliar to everyone. However, many patients may not know much about the treatment of pituitary tumors. Clinically, treatment plans are mainly formulated based on the size of the tumor, the time of onset, and the symptoms of the disease. So, what are the commonly used treatments for pituitary adenoma? Let us listen to the experts' introduction.

The treatment of pituitary tumors mainly includes three treatment methods: surgery, drugs and radiotherapy. Because there is no method that can completely cure every pituitary tumor, each treatment method has its own advantages and disadvantages. An individualized treatment plan should be formulated based on the size of the patient's pituitary tumor, hormone secretion, complications and comorbidities, the patient's age, whether there is a desire to have children, and the patient's financial situation.

Regarding radiotherapy, since pituitary tumors are adenomas, they have poor sensitivity to radiotherapy. After radiotherapy, nearly 70-80 percent of patients experience hypopituitarism, which reduces their quality of life. Therefore, radiotherapy is only suitable for patients with surgical remnants, cannot tolerate surgery, are insensitive to drugs, or have comorbidities that prevent them from undergoing surgery or drug treatment.

Drug treatment In recent years, with the continuous improvement of drug research and development, the drug treatment of hormone-secreting pituitary tumors has made great progress.

For pituitary prolactin-secreting tumors, the current view is that more than 90% of patients (whether microadenomas or macroadenomas) can use dopamine agonists (short-acting preparations of bromocriptine, long-acting preparations of cabergoline) to control PRL levels and reduce the size of the tumor. Only those prolactinoma patients who are allergic to or intolerant of such drugs, who have acute symptoms caused by tumor compression and need emergency surgery to relieve pressure, or who are unwilling to undergo surgical treatment, choose surgical treatment. During the treatment with bromocriptine, the dose of bromocriptine should be gradually increased until the serum PRL level drops to normal levels, and then the dose should be adjusted for long-term maintenance treatment. For patients who want to have children, bromocriptine should be discontinued after pregnancy. Regularly review the visual field during pregnancy until bromocriptine treatment is resumed after delivery. For patients who stop taking bromocriptine after pregnancy and experience miscarriage or stillbirth, they should continue to take the medicine until the dose of bromocriptine is adjusted after delivery. A large amount of clinical experience has shown that children born during the period when pregnant women take bromocriptine have not yet shown obvious deformities and intellectual disabilities.

For growth hormone-secreting pituitary tumors, the main progress in the past 20 years is the application of somatostatin analogs. The clinical application of this drug has significantly improved the cure rate of GH-secreting tumors. In recent years, long-acting somatostatin analogs such as long-acting octreotide and somadulin have been used in clinical practice, which has greatly improved patient compliance. The preoperative application of this type of drug can quickly reduce the patient's serum GH level, alleviate the patient's symptoms, reduce the size of the tumor, and create good preoperative conditions for complete surgical removal of the tumor. Other indications for somatostatin analogs for GH-secreting tumors include: transitional treatment for residual patients after surgery and patients whose GH has not yet been reduced to normal after radiotherapy. After the application of growth hormone analogs, patients with heart failure, sleep apnea, poorly controlled hyperglycemia, hypertension, and patients who cannot tolerate anesthesia are provided with an opportunity for preoperative preparation and treatment. In foreign countries, many patients who are unwilling to undergo surgical treatment have long-term use of somatostatin to control tumors because they do not have to worry about medical expenses, and have also achieved satisfactory treatment results. Somatostatin analogs have also achieved satisfactory treatment results for thyroid-stimulating hormone-secreting tumors. After the application of drugs to treat GH-secreting pituitary tumors, it is now recognized that the goal of biochemical cure is to reduce the GH level of patients with GH-secreting tumors to less than 1ng/dl (GH value after taking sugar) and reduce insulin-like growth factor (IGF-1) to the level of age-matched normal people. Regardless of the treatment, patients with growth hormone-secreting tumors should achieve the following treatment goals: eliminate the tumor, reduce the recurrence of the tumor, achieve GH standards, relieve clinical symptoms, preserve pituitary function as much as possible, improve the patient's quality of life, and prolong the patient's life span.

The above is an introduction to the treatment methods of pituitary tumors. I hope it will be helpful to you.