Management of aggressive pituitary adenomas: current treatment strategies

被引:56
作者
Buchfelder, Michael [1 ]
机构
[1] Univ Erlangen Nurnberg, Dept Neurosurg, D-91054 Erlangen, Germany
关键词
Pituitary adenoma; Surgery; Pharmacotherapy; Radiotherapy; Chemotherapy; LONG-TERM; SOMATOSTATIN ANALOGS; DOPAMINE AGONISTS; PRIMARY THERAPY; TEMOZOLOMIDE; CABERGOLINE; MACROPROLACTINOMA; MACROADENOMAS; TOLERABILITY; SHRINKAGE;
D O I
10.1007/s11102-008-0153-z
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aggressive pituitary adenomas are notoriously difficult to manage due to their size, invasiveness, speed of growth and high frequency of recurrence. Except for prolactinomas, surgery (usually transsphenoidal but sometimes transcranial) is the first-line option, but re-growth of aggressive tumors is almost inevitable and monitoring and repeat surgery is required to control symptoms. In prolactinomas, dopamine agonists are the first-line treatment and they normalize prolactin levels in most patients even with macroprolactinomas. Somatostatin analogues offer another pharmacotherapy for pituitary adenomas either for primary therapy, pre-operatively to reduce the tumor volume and make it more amenable to surgical removal, or post-surgery to control re-expansion. When surgery and pharmacotherapy fail, radiotherapy is a useful third-line strategy that reduces recurrence, while extreme pituitary adenomas with metastases may potentially be managed with chemotherapy (although more data are needed). A combination of these therapies will be required for aggressive pituitary adenomas and careful follow-up is essential.
引用
收藏
页码:256 / 260
页数:5
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