Medications have become available for selected
types of tumors. These drugs may be quite effective in some circumstances:
Dopamine agonists are effective in lowering prolactin levels and
may even shrink the size of a prolactin-secreting tumor.
Dostinex, a long-acting dopamine agonist. Dostinex
(cabergoline tablets) joins bromocriptine as a drug product indicated
to treat hyperprolactinemia, however, Dostinex is more convenient
for patients (two doses per week for Dostinex versus one to three
doses each day for bromocriptine). Dostinex is an effective and
generally well tolerated.
is a dopamine agonists. Long-term treatment may be necessary. With
treatment, regular menses are usually restored and galactorrhea
stopped. Successful pregnancies have been accomplished with the
delivery of healthy children. However, these agents do tend to produce
frequent side effects such as nausea, weakness, and dizziness.
Pergolide Mesylate (Permax) A ergoline derivative,
pergolide mesylate, effectively inhibits PRL secretion and is an
option for the medical treatment of prolactinomas. This dopamine
agonist is approximately 100 times more potent than BC and suppresses
PRL secretion for up to 24 h after a single dose, allowing effective
control of hyperprolactinemia with once daily dosing. Pergolide
is approved in the United States only for the therapy of Parkinson’s
disease, where it has been used safely at doses more than 10 times
those used for PRL-secreting tumors.
Octreotide. This injectable medication is particularly
useful in lowering growth hormone secretion. It is important to
remember that drug therapy may only control the secretion of some
tumors and not actually decrease the size of the tumor. The persistence
of these tumors may necessitate long-term administration of the
Somavert is the first in a new class of medicines
called growth hormone receptor antagonists and the only medicine
designed to specifically block the effects of excess growth hormone
Somavert (pegvisomant), an analog of human growth hormone, is an
injectable medication that has been structurally altered to act
as a growth hormone (GH) receptor antagonist. Over production of
growth hormone leads to abnormally high insulin-like growth factors
(IGF-I), which then cause acromegaly like symptoms.
Sandostatin® LAR Depot (octreotide acetate for injectable suspension) has demonstrated strong evidence and has been a trusted medical therapy.
Sandostatin® is a type of medical treatment for acromegaly called a somatostatin analogue. Sandostatin® LAR Depot works by reducing both growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels
Cortisol-reducing drugs. Although there is no medication to control
Cushing's disease, a few drugs have been used with varying success.
Agents, such as ketoconazole, metyrapone, and mitotane, work
to lower the secretion of the adrenal steroids.
Korlym™ (mifepristone) is a cortisol receptor blocker indicated to control hyperglycemia secondary to hypercortisolism in adult patients with endogenous Cushing’s syndrome who have type 2 diabetes mellitus or glucose intolerance and have failed surgery or are not candidates for surgery.
Diagnosis of Pituitary Adenomas
The symptoms of a pituitary adenoma vary with the
hormone(s) being secreted. These symptoms can range from the absence
of menstruation (amenorrhea) or inappropriate lactation (galactorrhea)
often seen in women with prolactin-secreting tumors to the enlargement
of the hands, feet, and jaw associated with growth hormone-secreting
tumors. The table below outlines the various symptoms by tumor type.
There are also more general symptoms, including headaches, visual
disturbances, and nausea, that can be caused by any type of pituitary
tumor. These symptoms often occur if the tumor becomes large enough
to compress neighboring structures, including the brain and optic
If any of these symptoms are present in an individual, several tests
may be done to confirm the diagnosis of a pituitary adenoma. Blood
tests are generally performed to determine hormone levels. Blood
tests can also determine whether any hormone excess is the result
of pituitary dysfunction.
In addition, a magnetic resonance imaging (MRI) scan can reveal
whether or not the pituitary gland is enlarged. The results of each
test are examined by an endocrinologist in order to confirm the
diagnosis of a pituitary adenoma and to form a treatment plan.
Treatment of Pituitary Adenomas
The treatment plan will be specific for each tumor
type, as well as for each patient, and may include surgery, radiation,
and/or drug therapy. The most common methods of treatment for the
most prevalent tumor types are outlined in the table below. Treatment
may include only one or a combination of these methods.
STANDARD TREATMENT OPTIONS
Based on the known slow growth of most pituitary tumors, the physician
may recommend observation only for the patient who does not have any evidence of a hormonal syndrome and as long as the tumor does
not compress the optic chiasm or nerves. This is more likely to
be the case for older patients. Tumors in younger patients have
a longer time to grow and therefore other forms of treatment may
be recommended. The size of the tumor is significant as well as surrounding structures. Tumors over 10 mm must be seriously evaluated.
Observation as a management recommendation means that the patient
is followed closely and the tumor is reimaged by MRI at reasonable
intervals. In general, MRI scans are performed more frequently during
the first year after diagnosis. Once the stability of the tumor
has been established, MRI scans may be taken less frequently. With
observation, the patient is followed in this fashion until any tumor
growth is noted on the MRI scans. If growth should occur, then appropriate
treatment is recommended at that time.
1st treatment is usualy surgery for ACTH or GH secreting tumors, large non secreting tumors and prolactinoma's that do not respond to medications. If the surgery is not succesful or can not be done radiation and gamma knife radiation are 2nd options. As previously listed medications are available to controll secreting pituitary adenoma's