Pituitary adenomas-not always benign

With a prevalence of 80-100/100,000, pituitary adenomas are more frequent than generally thought; however, they are frequently diagnosed only years after the development of initial symptoms. Particularly the rare aggressive forms of pituitary adenoma represent a special challenge. To present an update on the diagnostic and therapeutic management of pituitary adenomas. Review of the literature. In hormonally inactive pituitary adenomas surgery should be postponed until local symptoms, clinically relevant tumor growth or development of pituitary insufficiency are observed. Prolactinomas are usually treated with medication but surgery may be provided as first line therapy depending on tumor size and patient preference. For acromegaly, the delay in diagnosis after the initial symptoms develop is still significant so that patients usually present with macroadenomas. Treatment often needs a combination of surgery and medical treatment. Cushing's disease requires a meticulous diagnostic confirmation and is treated by surgery. In recent years various medication treatment approaches have been licensed to improve the treatment in patients with residual tumor tissue or recurrences. The prognosis of aggressive pituitary adenomas has been improved due to recent studies, which have demonstrated the effectiveness of chemotherapy with temozolomide. The management of pituitary adenomas still represents a major challenge due to the heterogeneous clinical presentation of the disease. Patients should be treated by a team consisting of at least an endocrinologist, neurosurgeon, radiation oncologist and pathologist.