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Management of aggressive growth hormone secreting pituitary adenomas

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Abstract

Aggressive GH-secreting pituitary adenomas (GHPAs) represent an important clinical problem in patients with acromegaly. Surgical therapy, although often the mainstay of treatment for GHPAs, is less effective in aggressive GHPAs due to their invasive and destructive growth patterns, and their proclivity for infrasellar invasion. Medical therapies for GHPAs, including somatostatin analogues and GH receptor antagonists, are becoming increasingly important adjuncts to surgical intervention. Stereotactic radiosurgery serves as an important fallback therapy for tumors that cannot be cured with surgery and medications. Data suggests that patients with aggressive and refractory GHPAs are best treated at dedicated tertiary pituitary centers with multidisciplinary teams of neuroendocrinologists, neurosurgeons, radiation oncologists and other specialists who routinely provide advanced care to GHPA patients. Future research will help clarify the defining features of “aggressive” and “atypical” PAs, likely based on tumor behavior, preoperative imaging characteristics, histopathological characteristics, and molecular markers.

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Authors and Affiliations

  1. Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA

    Daniel A. Donoho & Gabriel Zada

  2. Division of Endocrinology, Department of Medicine, Keck School of Medicine of the University of Southern California, USC Pituitary Center, 1520 San Pablo Street #3800, Los Angeles, CA, 90033, USA

    Namrata Bose & John D. Carmichael

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  1. Daniel A. Donoho
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  2. Namrata Bose
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Correspondence to John D. Carmichael.

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John Carmichael is a principal investigator for and USC has received grants for research from Novartis, Chiasma, and Pfizer. Dr. Carmichael has also served as an advisory board member for Chiasma, Novartis, and Pfizer.

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Donoho, D.A., Bose, N., Zada, G. et al. Management of aggressive growth hormone secreting pituitary adenomas. Pituitary 20, 169–178 (2017). https://doi.org/10.1007/s11102-016-0781-7

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