Giant pituitary adenoma: histological types, clinical features and therapeutic approaches.
Pedro IglesiasVíctor Rodríguez BerrocalJuan José DíezPublished in: Endocrine (2018)
Giant pituitary adenomas comprise about 6-10% of all pituitary tumors. They are mostly clinically non-functioning adenomas and occur predominantly in males. The presenting symptoms are usually secondary to compression of neighboring structures, but also due to partial or total hypopituitarism. Functioning adenomas give rise to specific symptoms of hormonal hypersecretion. The use of dopamine agonists is considered a first-line treatment in patients with giant macroprolactinomas. Somatostatin analogs can also be used as primary treatment in cases of growth hormone and thyrotropin producing giant adenomas, although remission of the disease is not achieved in the vast majority of these patients. Neurosurgical treatment, either through transsphenoidal or transcranial surgery, continues to be the treatment of choice in the majority of patients with giant pituitary adenomas. The intrinsic complexity of these tumors requires the use of different therapies in a combined or sequential way. A multimodal approach and a therapeutic strategy involving a multidisciplinary team of expert professionals form the basis of the therapeutic success in these patients.
Keyphrases
- growth hormone
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- minimally invasive
- prognostic factors
- rare case
- quality improvement
- chronic pain
- rheumatoid arthritis
- adipose tissue
- systemic lupus erythematosus
- high resolution
- mass spectrometry
- decision making
- insulin resistance
- patient reported outcomes
- skeletal muscle
- polycystic ovary syndrome
- ulcerative colitis
- atrial fibrillation