Overview of Pituitary Tumor Treatment

  • Peter O. Kohler


Major advances in the diagnostic and therapeutic approaches to pituitary tumors have occurred over the past two decades. As a result of the increased capacity to detect and treat pituitary microadenomas, the goals of treatment are now often different. Several years ago, the diagnosis of pituitary tumor was most often made in patients over 40 years of age.1 Frequently, the presenting complaints include visual defects, indicating relatively large tumors.2 In addition, most pituitary tumors were believed to be nonfunctional because (1) no hypersecretory syndrome was clearly identified in approximately 75% of patients and (2) on histological examination, the tumor cells showed no specific chromophilic hormone granules. The therapeutic goal in patients with these so-called “chromophobe adenomas” was often to prevent expansion or control tumor growth and avoid the visual and endocrine deficiencies caused by the mass effect of the tumor. Total resection of the tumor was not necessarily recommended because of the high incidence of complete pituitary dysfunction and fatality.3 Therapy for these tumors was usually either trans-frontal surgery,1 external irradiation,4 or a combination of both.5


Pituitary Adenoma Pituitary Tumor Acromegalic Patient Transsphenoidal Surgery Sella Turcica 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    L. Bakay, Results of 300 pituitary tumor operations (Prof. Herbert Olivecrona’s series), J. Neurosurg. 7:240–255, 1950.PubMedCrossRefGoogle Scholar
  2. 2.
    R.W. Hollenhorst and B.R. Younge, Ocular manifestations produced by adenomas of the pituitary gland: Analysis of 1000 cases, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 53–64, Exerpta Medica, Amsterdam, 1973.Google Scholar
  3. 3.
    F.C. Grant, Pituitary tumors, Surg. Gynecol. Obstet. 90:629–631, 1950.Google Scholar
  4. 4.
    G.E. Sheline, Proceedings: Treatment of nonfunctioning chromophobe adenomas of the pituitary, Am. J. Roentgenol. 120:553–561, 1974.Google Scholar
  5. 5.
    C.A. Fager, J.L. Poppen, and Y. Takaoka, Indications for and results of surgical treatment of pituitary tumors by the intracranial approach, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 146–155, Exerpta Medica, Amsterdam, 1973.Google Scholar
  6. 6.
    J.F. Annegers, C.B. Coulam, C.F. Abboud, E.R. Laws, and L.T. Kurland, Pituitary adenoma in Olmsted County, Minnesota, 1935–1977, Mayo Clin. Proc. 53:641–643, 1978.PubMedGoogle Scholar
  7. 7.
    S. Franks, J.D.N. Nabarro, and H.S. Jacobs, Prevalence and presentation of hyperprolac-tinaemia in patients with “functionless” pituitary tumors, Lancet 1:788–780, 1977.Google Scholar
  8. 8.
    A.G. Franz, Prolactin, N. Engl. J. Med. 298:201–207, 1978.CrossRefGoogle Scholar
  9. 9.
    B. Kaufman, The “empty” sella turcica: A manifestation of the intrasellar subarachnoid space, Radiology 90:931–941, 1968.PubMedGoogle Scholar
  10. 10.
    G.E. Sheline, Treatment of chromophobe adenomas of the pituitary gland and acromegaly, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 201–216, Exerpta Medica, Amsterdam, 1973.Google Scholar
  11. 11.
    L.A. Weisberg, Asymptomatic enlargement of the sella turcica, Arch. Neurol. 32:483–485, 1975.PubMedCrossRefGoogle Scholar
  12. 12.
    D.A. Pistenma, D.R. Goffinet, M.A. Bagshaw, J.W. Hanbery, and J.R. Eltringham, Treatment of chromophobe adenomas with megavoltage irradiation, Cancer 35:1574–1582, 1975.PubMedCrossRefGoogle Scholar
  13. 13.
    N. Urdaneta, H. Chessin, and J.J. Fischer, Pituitary adenomas and craniopharyngiomas: Analysis of 99 cases treated with radiation therapy, Int. J. Radiat. Oncol. Biol. Phys. 1:895–902, 1976.PubMedCrossRefGoogle Scholar
  14. 14.
    A.R.C. Amine and O. Sugar, Suprasellar osteogenic sarcome following radiation for pituitary adenoma, J. Neurosurg. 44:88–91, 1976.PubMedCrossRefGoogle Scholar
  15. 15.
    J.C. Gonzalez-Vitale, R.E. Slavin, and J.D. McQueen, Radiation-induced intracranial malignant fibrous histiocytoma, Cancer 37:2960–2963, 1976.PubMedCrossRefGoogle Scholar
  16. 16.
    A.N. Martins, J.S. Johnston, J.M. Henry, T.J. Stoffel, and G. DiChiro, Delayed radiation necrosis of the brain, J. Neurosurg. 47:336–345, 1977.PubMedCrossRefGoogle Scholar
  17. 17.
    H. Cushing, the Weir Mitchell lecture: Surgical experiences with pituitary disorders, J. Am. Med. Assoc. 63:1515–1525, 1914.CrossRefGoogle Scholar
  18. 18.
    B.S. Ray and R.H. Patterson, Jr., Surgical treatment of pituitary adenomas, J. Neurosurg. 19:1–8, 1962.PubMedCrossRefGoogle Scholar
  19. 19.
    C.S. MacCarty, E.J. Hanson Jr., R.V. Randall, and P.W. Scanion, Indications for and results of surgical treatment of pituitary tumors by the transfrontal approach, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 139–145, Exerpta Medica, Amsterdam, 1973.Google Scholar
  20. 20.
    R.L. Atkinson, D.F. Becker, A.N. Martins, M. Schaaf, R.C. Dimond, L. Wartofsky, and j.m. Earll, Acromegaly: Treatment by transsphenoidal microsurgery, J. Am. Med. Assoc. 233:1279–1283, 1975.CrossRefGoogle Scholar
  21. 21.
    G. Guiot, Transsphenoidal approach in surgical treatment of pituitary adenomas: General principles and indications in non-functioning adenomas, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 159–178, Exerpta Medica, Amsterdam, 1973.Google Scholar
  22. 22.
    J. Roth, P. Gorden, and K. Brace, Efficacy of conventional pituitary irradiation in acromegaly, N. Engl. J. Med. 282:1385–1391, 1970.PubMedCrossRefGoogle Scholar
  23. 23.
    B.S. Ray, M. Horwith, and C. Mautalen, Surgical hypophysectomy as a treatment for acromegaly, in: Clinical Endocrinology II (E.B. Astwood and C.E. Cassidy, eds.), pp. 93–102, Grune and Stratton, New York, 1968.Google Scholar
  24. 24.
    J. Hardy, Transsphenoidal surgery of hypersecreting pituitary tumors, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 179–194, Exerpta Medica, Amsterdam, 1973.Google Scholar
  25. 25.
    R.N. Kjellberg and B. Kliman, A system for therapy of pituitary tumors, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 234–252, Exerpta Medica, Amsterdam, 1973.Google Scholar
  26. 26.
    J.H. Lawrence, C.A. Tobias, J.A. Linfoot, J.L. Born, J.T. Lyman, C.Y. Chong, E. Manougian, and W.C. Wei, Successful treatment of acromegaly: Metabolic and clinical studies in 145 patients, J. Clin. Endocrinol. Metab. 31:180–198, 1970.PubMedCrossRefGoogle Scholar
  27. 27.
    A.M. Lawrence, S.M. Pinsky, and I.D. Goldfine, Conventional radiation therapy in acromegaly, Arch. Intern. Med. 128:369–377, 1971.PubMedCrossRefGoogle Scholar
  28. 28.
    D.A. Pistenma, D.R. Goffinet, M.A. Bagshaw, J.W. Hanbery, and J.R. Eltringham, Treatment of acromegaly with megavoltage radiation therapy, Int. J. Radiat Oncol. Biol. Phys. 1:885–893, 1976.PubMedCrossRefGoogle Scholar
  29. 29.
    A.L. Taylor, J.L. Finster, P. Raskin, J.B. Field, and D.H. Mintz, Pituitary apoplexy in acromegaly, J. Clin. Endocrinol. Metab. 28:1784–1792, 1968.PubMedCrossRefGoogle Scholar
  30. 30.
    R. Eastman, P. Gorden, and J. Roth, Conventional supervoltage irradiation is effective therapy for acromegaly, J. Clin. Endocr. Metab. 48:931–940, 1979.PubMedCrossRefGoogle Scholar
  31. 31.
    A.M. Lawrence and T.C. Hagen, Alternatives to ablative therapy for pituitary tumors, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 298–312, Exerpta Medica, Amsterdam, 1973.Google Scholar
  32. 32.
    K. Nakagawa and K. Mashimo, Suppressibility of plasma growth hormone levels in acromegaly with dexamethasone and phentolamine, J. Clin. Endocrinol. Metab. 37:238–246, 1973.PubMedCrossRefGoogle Scholar
  33. 33.
    J.M. Feldman, J.W. Plonk, and C.H. Bivins, Inhibitory effect of serotonin antagonists on growth hormone release in acromegalic patients, Clin. Endocrinol. 5:71–78, 1976.Google Scholar
  34. 34.
    G. Delitala, A. Masala, S. Alagna, L. Devilla, and G. Lotti, Growth hormone and prolactin release in acromegalic patients following metergoline administration, J. Clin. Endocrinol. Metab. 43:1382–1386, 1976.PubMedCrossRefGoogle Scholar
  35. 35.
    J.A.H. Wass, M.O. Thorner, D.V. Morris, L.H. Rees, A.S. Mason, A.E. Jones, and G.M. Besser, Long-term treatment of acromegaly with bromocryptine, Br. Med. J. 1:875–878, 1977.PubMedCrossRefGoogle Scholar
  36. 36.
    G. Benker, W. Zah, K. Hackenberg, B. Hamberger, H. Gunnewig, and D. Reinwein, Long-term treatment of acromegaly with bromocryptine: Postprandial HGH levels and response to TRH and glucose administration, Horm. Metab. Res. 8:291–295, 1976.PubMedCrossRefGoogle Scholar
  37. 37.
    V.K. Summers, L.J. Hipkin, M.J. Diver, and J.C. Davis, Treatment of acromegaly with bromocryptine, J. Clin. Endocrinol. Metab. 40:904–906, 1975.PubMedCrossRefGoogle Scholar
  38. 38.
    I.D. Goldfine and A.M. Lawrence, Hypopituitarism in acromegaly, Arch. Intern. Med. 130:720–723, 1972.PubMedCrossRefGoogle Scholar
  39. 39.
    D.M. Dawson and J.F. Dingman, Hazards of proton beam pituitary irradiation, N. Engl. J. Med. 282:1434, 1970.PubMedGoogle Scholar
  40. 40.
    R. Fraser, F. Doyle, G.F. Joplin, C.W. Burke, P. Harsoulis, M. Tunbridge, R. Arnott, and D. Child, The assessment of the endocrine effects and the effectiveness of ablative pituitary treatment by 90Y or 198Au implantation, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 35–46, Exerpta Medica, Amsterdam, 1973.Google Scholar
  41. 41.
    L.M. Davidoff, Studies in acromegaly: The anamnesis and symptomatology in one hundred cases, Endocrinology 10:461–483, 1926.CrossRefGoogle Scholar
  42. 42.
    S.R. Levin, Medical Staff Conference: Manifestations of acromegaly, Calif. Med. 116:57–64, 1972.Google Scholar
  43. 43.
    J. Hardy, Transsphenoidal microsurgical treatment of pituitary tumors, in: Recent Advances in the Diagnosis and Treatment of Pituitary Tumors (J.A. Linfoot, ed.), pp. 375–378, Raven Press, New York, 1979.Google Scholar
  44. 44.
    D.L. Kleinberg, G.L. Noel, and A.G. Frantz, Galactorrhea: A study of 235 cases including 48 with pituitary tumor, N. Engl. J. Med. 296:589–600, 1977.PubMedCrossRefGoogle Scholar
  45. 45.
    A.E. Boyd, S. Reichlin, and R.N. Turksoy, Galactorrhea-amenorrhea syndrome: Diagnosis and therapy, Ann. Intern. Med. 87:165–175, 1977.PubMedGoogle Scholar
  46. 46.
    C.B. Wilson and L.C. Dempsey, Transsphenoidal microsurgical removal of 250 pituitary adenomas, J. Neurosurg. 48:13–22, 1978.PubMedCrossRefGoogle Scholar
  47. 47.
    K.D. Post, B.J. Biller, L.S. Adelman, M.E. Molitch, S.M. Wolpert, and S. Reichlin, Results of selective transsphenoidal adenomectomy in women with galactorrhea—amenorrhea, J. Am. Med. Assoc. 242:158–162, 1979.CrossRefGoogle Scholar
  48. 48.
    D.F. Child, S. Nader, K. Mashiter, M. Kjeld, L. Banks, and T.R. Fraser, Prolactin studies in “functionless” pituitary tumors, Br. Med. J. 1:604–606, 1975.PubMedCrossRefGoogle Scholar
  49. 49.
    N.A. Samaan, M.E. Leavens, and J.H. Jesse, Jr., Serum prolactin in patients with “functionless” chromophobe adenomas before and after therapy, Acta Endocrinol. 84:449–460, 1977.PubMedGoogle Scholar
  50. 50.
    J.N. Carter, J.E. Tyson, G. Tolis, S. Van Vliet, C. Faiman, and H. Friesen, Prolactin-secreting tumors and hypogonadism in 22 men, N. Engl. J. Med. 299:847–852, 1978.PubMedCrossRefGoogle Scholar
  51. 51.
    W.B. Malarkey, L.S. Jacobs, and W.H. Daughaday, Levodopa suppression of prolactin in nonpuerperal galactorrhea, N. Engl. J. Med. 285:1160–1163, 1971.PubMedCrossRefGoogle Scholar
  52. 52.
    E. del Pozo and I. Lancranjan, Clinical use of drugs modifying the release of anterior pituitary hormones, in: Frontiers in Neuroendocrinology, Vol. 5, (W.F. Ganong and L. Martini, eds.), pp. 207–247, Raven Press, New York, 1978.Google Scholar
  53. 53.
    M.O. Thorner, G.M. Besser, A. Jones, J. Dacie, and A.E. Jones, Bromocryptine treatment of female infertility: Results of 13 pregnancies, Br. Med. J. 4:694–697, 1975.PubMedCrossRefGoogle Scholar
  54. 54.
    T. Bergh, S.J. Nillius, and L. Wide, Clinical course and outcome of pregnancies in amenor-rhoeic women with hyperprolactinaemia and pituitary tumors, Br. Med. J. 1:875–880, 1978.PubMedCrossRefGoogle Scholar
  55. 55.
    S. Reichlin, The prolactinoma problem (editorial), N. Engl. J. Med. 300:313–315, 1979.PubMedCrossRefGoogle Scholar
  56. 56.
    A.M. McGregor, M.F. Scanlon, K. Hall, D.B. Cook, and R. Hall, Reduction in size of a pituitary tumor by bromocryptine therapy, N. Engl. J. Med. 300:291–293, 1979.PubMedCrossRefGoogle Scholar
  57. 57.
    J.A. Linfoot, Heavy ion therapy: Alpha particle therapy of pituitary tumors, in: Recent Advances in the Diagnosis and Treatment of Pituitary Tumors (J.A. Linfoot, ed.), pp. 245–267, Raven Press, New York, 1979.Google Scholar
  58. 58.
    J. Hardy, H. Beauregard, and F. Robert, Prolactin-secreting pituitary adenomas: Transsphenoidal microsurgical treatment, in: Progress in Prolactin Physiology and Pathology (C. Robyn and M. Harter, eds.), pp. 361–369, Elsevier North-Holland, Amsterdam, 1978.Google Scholar
  59. 59.
    F.T. Murray, J. Osterman, J. Sulewski, R. Page, R. Bergland, and J.M. Hammond, Alterations in pituitary function following surgical removal of prolactin-secreting pituitary tumors, Obstet. Gynecol. 54:65–73, 1979.PubMedCrossRefGoogle Scholar
  60. 60.
    R. Momex, J. Orgiazzi, B. Hugues, J. Gagnaire, and B. Claustrat, Normal pregnancies after treatment of hyperprolactinemia with bromergocryptine, despite suspected pituitary tumors, J. Clin. Endocrinol. Metah. 47:290–295, 1978.CrossRefGoogle Scholar
  61. 61.
    I. Ernest and H. Ekman, Adrenalectomy in Cushing’s disease: A long-term follow-up, Acta Endocrinol. 69(Suppl. 160):5–41, 1972.Google Scholar
  62. 62.
    D.N. Orth and G.W. Liddle, Results of treatment of 108 patients with Cushing’s syndrome, N. Engl. J. Med. 285:243–247, 1971.PubMedCrossRefGoogle Scholar
  63. 63.
    G.W. Liddle, Tests of pituitary-adrenal suppressibility in the diagnosis of Cushing’s syndrome, J. Clin. Endocrinol Metah. 20:1539–1560, 1960.CrossRefGoogle Scholar
  64. 64.
    J.B. Tyrrell, R.M. Brooks, P.A. Fitzgerald, P.M. Cofoid, P.H. Forsham, and C.B. Wilson, Cushing’s disease: Selective transsphenoidal resection of pituitary microadenomas, N. Engl. J. Med. 298:753–758, 1978.PubMedCrossRefGoogle Scholar
  65. 65.
    W.J. Jeffcoate, L.H. Rees, S. Tomlin, A.E. Jones, C.R.W. Edwards, and G.M. Besser, Me-tyrapone in long-term management of Cushing’s disease, Br. Med. J. 2:215–217, 1977.PubMedCrossRefGoogle Scholar
  66. 66.
    R.I. Misbin, J. Canary, and D. Willard, Aminoglutethamide in the treatment of Cushing’s syndrome, J. Clin. Pharmacol. 16:645–651, 1976.PubMedGoogle Scholar
  67. 67.
    D. T. Kriogor, L. Amorosa, and F. Linick, Cyproheptadine in duced remission of Cushing’s disease, N. Engl. J. Med. 293:893–896, 1975.CrossRefGoogle Scholar
  68. 68.
    D.T. Krieger, Pharmacological therapy of Cushing’s disease and Nelson’s syndrome, in: Recent Advances in Diagnosis and Treatment of Pituitary Tumors (J.A. Linfoot, ed.), pp. 337–340, Raven Press, New York, 1979.Google Scholar
  69. 69.
    S. Aristizabal, W.L. Caldwell, J. Avila, and E.G. Mayer, Relationship of time dose factors to tumor control and complications of treatment of Cushing’s disease by irradiation, Int. J. Radiat Oncol Biol. Phys. 2:47–54, 1977.PubMedGoogle Scholar
  70. 70.
    T.J. Moore, R.G. Dluhy, G.H. Williams, and J.P. Cain, Nelson’s syndrome: Frequency, prognosis, and effect of prior pituitary irradiation, Ann. Intern. Med. 85:731–734, 1976.PubMedGoogle Scholar
  71. 71.
    A.S. Jennings, G.W. Liddle, and D.N. Orth, Results of treating childhood Cushing’s disease with pituitary irradiation, N. Engl. J. Med. 297:957–962, 1977.PubMedCrossRefGoogle Scholar
  72. 72.
    S. Aristizabal, W.L. Caldwell, and J. Avila, The relationships of time-dose fractionation factors to complications in the treatment of pituitary tumors by irradiation, Int. J. Radiât. Oncol. Biol. Phys. 1:667–673, 1977.CrossRefGoogle Scholar
  73. 73.
    J.H. Lawrence, C.A. Tobias, J.A. Linfoot, J.L. Born, and C.Y. Chong, Heavy particle therapy in acromegaly and Cushing’s disease, J. Am. Med. Assoc. 235:2307–2310, 1976.CrossRefGoogle Scholar
  74. 74.
    E.M. Gold, The Cushing’s syndromes: Changing views of diagnosis and treatment, Ann. Intern. Med. 90:829–844, 1979.PubMedGoogle Scholar
  75. 75.
    C.R. Hamilton, Jr., L.C. Adams, and F. Maloof, Hyperthyroidism due to a thyrotropin-produc-ing pituitary chromophobe adenoma, N. Engl. J. Med. 283:1077–1080, 1970.PubMedCrossRefGoogle Scholar
  76. 76.
    P.J. Snyder and F.H. Sterling, Hypersecretion of LH and FSH by a pituitary adenoma, J. Clin. Endocrinol. Metab. 42:544–550, 1976.PubMedCrossRefGoogle Scholar
  77. 77.
    A.M. Lawrence, J.F. Wilber, and T.C. Hogan, The pituitary and primary hypothyroidism, Arch. Intern. Med. 132:327–333, 1973.PubMedCrossRefGoogle Scholar
  78. 78.
    N.A. Samaan, A.V. Stepanas, J. Danziger, and J. Trujillo, Reactive pituitary abnormalities in patients with Klinefelter’s and Turner’s syndromes, Arch. Intern. Med. 139:198–201, 1979.PubMedCrossRefGoogle Scholar
  79. 79.
    S.T. Bigos, M. Somma, E. Rasio, R.C. Eastman, A. Lanthier, H.H. Johnson, and J. Hardy, Cushing’s disease: Management by transsphenoidal pituitary microsurgery, J. Clin. Endocrinol. Metab. 50:348–354, 1980.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1980

Authors and Affiliations

  • Peter O. Kohler
    • 1
    • 2
  1. 1.University of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Little Rock Arkansas University HospitalLittle RockUSA

Personalised recommendations