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Non-functioning tumors - Treatment

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There are four treatment options for nonfunctioning pituitary tumors: observation, neurosurgery, radiation therapy, and medical therapy.

Observation

Observation without specific treatment can sometimes be appropriate for patients with nonfunctioning pituitary tumors, but this decision must be made carefully, and the patient must be closely followed. Observation is sometimes appropriate for smaller tumors that do not threaten vision or cause headaches or other symptoms. Most of these tumors are very slow growing, and tumors that are not causing any problems can sometimes safely be watched. Observation may also be appropriate in older patients even with large tumors who have other serious medical problems and do not have a long life-expectancy, since the slow-growing tumor may not cause any problems in the patient's lifetime. In most cases, however, these tumors should be treated.Hormone replacement therapy may be indicated, based on the results of the hormone-testing procedures.

Neurosurgery

In almost all cases, neurosurgery is the initial treatment of choice for nonfunctioning pituitary tumors. The surgery is usually performed through the nose ("transsphenoidal surgery"), which avoids having to dissect through the brain to reach the pituitary gland. The transsphenoidal route is appropriate even for very large tumors, since these tumors can usually be adequately debulked via this route, and since these tumors are rarely completely cured even with more aggressive, transcranial surgery. The goal in most cases of large tumors is to debulk the tumor, rather than attempt to completely remove it. In the case of smaller tumors, complete cure may be a reasonable goal.

The single most important factor in achieving optimal surgical results with large pituitary tumors (good debulking, few or no side effects, no damage to the normal pituitary gland and other normal structures) is an experienced surgeon with a good track record. Transsphenoidal surgery is best done by surgeons who perform many such operations every year, and have documented good results with low rates of complications.

Radiation therapy

Pituitary tumors are rarely treated primarily with radiation therapy, since radiation therapy takes many years to be effective, and usually leads to pituitary hormone deficiencies. However, in some cases, primary radiation therapy may be considered for these tumors. Newer methods for delivering radiation therapy to the pituitary gland (for example, the "gamma knife,") and appear to give more rapid results than traditional radiation therapy, though their effectiveness in controlling tumor growth is not necessarily greater.

Since many nonfunctioning pituitary tumors are large and cannot be completely removed by surgery, the issue of post-operative radiation therapy often arises. In many cases, the tumor has been sufficiently debulked and can be monitored without further treatment, even with known residual tumor present. In other cases, post-operative radiation therapy is recommended. This decision is based on patient characteristics, as well as the size, location, and expected aggressiveness of the residual tumor.

Medical therapy

Medical therapy has become important for the treatment of some functioning pituitary tumors, primarily prolactin and growth hormone secreting tumors. Unfortunately, no clearly effective medical therapy for nonfunctioning pituitary tumors is currently available. In some, but not all, patients in whom surgery has been only partially successful or is contraindicated, dopamine agonists (cabergoline) or somatostatin analogs (octreotide) have been effective in suppressing tumor growth. However, these drugs should not be used as primary therapy. At the present time, the best treatment option for nonfunctioning pituitary tumors remains neurosurgical, while medical therapy awaits the development of more specific and effective drugs.