Skip to main content
SpringerLink
Log in
Book cover

Radiotherapy for Non-Malignant Disorders pp 653–663Cite as

Pituitary Adenoma

  • Chapter

  • 2156 Accesses

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

Pituitary tumours grow slowly and are initially confined to the sella turcica. They may grow out of the sella and compress or destroy the optic chiasm, hypothalamus or surrounding bony structures. They are mostly benign and are associated with an immense diversity in their endocrine manifestations secondary to hormone excess or deficiency and ophthalmologic manifestations due to the mass effect of enlarging pituitary adenomas. Progress in the diagnostic examination of pituitary adenomas and advances in treatment of these tumours offer excellent prospects for a successful therapeutic outcome using a multidisciplinary approach. Therapeutic options for the treatment of pituitary adenomas have largely widened. Management by medical treatment, surgery or radiotherapy is possible. Treatment success depends on various factors, such as the tumour size, invasiveness, localisation, direction of growth or hormonal activity. The goals of pituitary adenoma therapy are to remove or to destroy the tumour, control hypersecretion and restore lost function without producing hypopituitarism or injury to surrounding normal tissue. There is therefore no doubt that the initial treatment for nonfunctional and hormonally active adenomas, except prolactinomas, is reserved to neurosurgery in operable patients [46, 68]. The reason is that surgical resection accomplishes these goals most rapidly, with prompt decompression of mass effects and improvement in pituitary function. In most cases, transsphenoidal or occasionally transethenoidal resection of the adenoma can be performed. Of particular interest was the development of microsurgical techniques, offering selective extraction of microadenomas [58]. For many pituitary adenomas, a major problem is the recurrent growth of tumours that are either primarily invasive or incompletely removed.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   189.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Aristizabal S, Caldwell WL, Avila J (1977) The relationship of time-dose fractionation to complications in the treatment of pituitary tumours by irradiation. Int J Radiat Oncol Biol Phys 2:667–673

    PubMed  CAS  Google Scholar 

  2. Becker G, Kocher M, Kortmann R-D et al (2002) Radiation therapy in the multimodal treatment approach of pituitary adenoma. Strahlenther Onkol 178:173–186

    Article  PubMed  Google Scholar 

  3. Benesch H, Felber SR, Finkenstedt G et al (1995) MR volumetry for monitoring intramuscular bromocriptine treatment in macroprolactinomas. J Comput Assist Tomogr 19:866

    Article  PubMed  CAS  Google Scholar 

  4. Brada M, Ford D, Ashley S (1992) Risk of second brain tumour after conservative surgery and radiation therapy for pituitary macroadenomas. BMJ 304:1343

    Article  PubMed  CAS  Google Scholar 

  5. Brada M, Rajan B, Traish D et al (1993) The long-term efficacy of conservative surgery and radiation therapy in the control of pituitary adenomas. Clin Endocrinol 38:571–578

    Article  CAS  Google Scholar 

  6. Brady LW, Antoniades J, Faust DS et al (1975) Radiation therapy in pituitary adenomas. In: Kryston LJ, Shaw RA (eds) Endocrinology and diabetes. Grune & Stratton, New York, pp 69–78

    Google Scholar 

  7. Breen P, Flickenger JC, Kondziolka D et al (1998) Radiotherapy for nonfunctional pituitary adenomas: analysis of long-term tumour control. J Neurosurg 89:933–938

    PubMed  CAS  Google Scholar 

  8. Chiodini P, Liuzzi A, Cozzi R et al (1981) Size reduction of macroprolactinomas by bromocriptine or lisuride treatment. J Clin Endocrinol Metab 53:737–743

    PubMed  CAS  Google Scholar 

  9. Chun M, Masko GB, Hetelekidis S (1988) Radiotherapy in the treatment of pituitary adenomas. Int J Radiat Oncol Biol Phys 15:305–309

    Article  PubMed  CAS  Google Scholar 

  10. Ciric I (2003) Long-term management and outcome for pituitary tumors. Neurosurg Clin N Am 14:167–171

    Article  PubMed  Google Scholar 

  11. Ciric I., Mikhael M., Stafford T, Lawson L, Garces R (1983) Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results. J Neurosurg 59:395–401

    Article  PubMed  CAS  Google Scholar 

  12. Clarke SD, Woo SY, Butler EB et al (1993) Treatment of secretory pituitary adenomas with radiation therapy. Radiology 188:759–763

    PubMed  CAS  Google Scholar 

  13. Colin P, Delemer B, Nakib I et al (2002) Unsuccessful surgery of Cushing’s disease. Role and efficacy of fractionated stereotactic radiation therapy. Neurochirurgie 48:285–293

    PubMed  CAS  Google Scholar 

  14. Duchstein S, Gademann G, Peters B (2003) Early and late effects of local high dose radiotherapy of the brain on memory and attention. Strahlenther Onkol 179:441–451

    PubMed  Google Scholar 

  15. Engenhart-Cabillic R, Kocher M, Müller RP et al (1999) Leitlinien zur Strahlentherapie von Hypophysenadenomen. Dtsch Med Wochenschr 124:1148–1152

    PubMed  CAS  Google Scholar 

  16. Escourolle H, Abecassis JP, Bertagna X et al (1993) Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing’s disease. Clin Endocrinol 39:307–313

    Article  CAS  Google Scholar 

  17. Estrada J, Boronat M, Mielgo M et al (1997) The longterm outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. N Engl J Med 336:172–177

    Article  PubMed  CAS  Google Scholar 

  18. Fahlbusch R, Giovanelli M, Crosignani PG et al (1980) Differentiated therapy of microprolactinomas: Significance of transsphenoidal adenomectomy. In: Faglia G, Giovanelli M, MacLeod RM (eds) Pituitary microadenomas. Academic Press, London, pp 443–456

    Google Scholar 

  19. Fahlbusch R, Thapar K (1999) New developments in pituitary surgical techniques. Best Pract Res Clin Endocrinol Metab 13:471–484

    Article  CAS  Google Scholar 

  20. Fisher BJ, Gaspar LE, Noone B (1993) Radiation therapy of pituitary adenoma: Delayed sequelae. Radiology 187:843–846

    PubMed  CAS  Google Scholar 

  21. Fraser R Doyle GF Joplin CW et al (1973) The assessment of endocrine effect and the effectiveness of the ablative pituitary treatment by 90Y and 198Au implantation. In: Kohler PO and Ross GT (eds) Pituitary tumours. Elsevier New York p 35

    Google Scholar 

  22. Fukamachi A, Wakao T, Akai J (1982) Brain stem necrosis after irradiation of pituitary adenoma. Surg Neurol 18:343–350

    Article  PubMed  CAS  Google Scholar 

  23. Goldsmith BJ, Rosenthal SA, Wara W et al (1992) Optic neuropathy after irradiation of meningioma. Radiology 185:71–76

    PubMed  CAS  Google Scholar 

  24. Grigsby PW, Sheline GE (1992) Pituitary. In: Perez CA, Brady LW (eds) Principles and practice of radiation oncology. JB Lippincott, Philadelphia, pp 564–582

    Google Scholar 

  25. Grigsby PW, Simpson JR, Emami BN et al (1989) Prognostic factors and results of surgery and postoperative irradiation in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys 16:1411–1417

    PubMed  CAS  Google Scholar 

  26. Grigsby PW, Simpson JR, Stokes SH et al (1988) Results of surgery and irradiation or irradiation alone for pituitary adenomas. J Neurooncol 6:129–134

    Article  PubMed  CAS  Google Scholar 

  27. Grigsby PW, Stokes S, Marks JE et al (1988) Prognostic factors and results of radiation therapy alone in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys 15:1103

    PubMed  CAS  Google Scholar 

  28. Halberg FE (1998) Pituitary tumours. In: Leibel S, Phillips T (eds) Textbook of radiation oncology. WB Saunders, Philadelphia, pp 357–369

    Google Scholar 

  29. Halberg FE, Sheline GE (1997) Radiation therapy of pituitary tumours. Endocrinol Metab Clin 16:667–684

    Google Scholar 

  30. Hardy J (1973) Transsphenoidal surgery of hypersecreting pituitary tumors. In: Kohler PO, Ross FT (eds) Diagnosis and treatment of pituitary tumors. Elsevier, New York, p 179

    Google Scholar 

  31. Harris JR, Levene MB (1976) Visual complications following irradiation for pituitary adenomas and craniopharyngiomas. Radiology 120:167–171

    PubMed  CAS  Google Scholar 

  32. Holm R (1995) Null cell adenomas and oncytomas of the pituitary gland. Pathol Res Pract 191:348–352

    PubMed  CAS  Google Scholar 

  33. Hughes MN, Llamas KJ, Yelland ME et al (1993) Pituitary adenomas: Long-term results for radiotherapy alone and postoperative radiotherapy. Int J Radiat Oncol Biol Phys 27:1035–1043

    PubMed  CAS  Google Scholar 

  34. Jaffe CA (1999) Reevaluation of conventional pituitary irradiation and the therapy of acromegaly. Pituitary 2:55–62

    Article  PubMed  CAS  Google Scholar 

  35. Jennings AS, Liddle GW, Orth DN (1977) Results of treating childhood Cushing’s disease with pituitary irradiation. N Engl J Med 297:957–962

    PubMed  CAS  Google Scholar 

  36. Joplin GF (1994) The management of pituitary adenomas by yttrium 90 interstitial irradiation. In: Lynn J, Bloom SR (eds) Surgical endocrinology. Butterworth-Heineman, London, p 155

    Google Scholar 

  37. Jordan RM, Kohler PO (1987) Recent advances in diagnosis and treatment of pituitary tumours. In: Stolerman G (ed) Advances in internal medicine, vol Yearbook Medical Publishers, Inc, Chicago, pp 299–323

    Google Scholar 

  38. Kernohan JW, Sayre GP (1956) Tumors of the pituitary gland and infundibulum, section X, fascicle Washington DC, Armed Forces Institute of Pathology, p 7

    Google Scholar 

  39. Kline LB, Kim JY, Ceballos R (1985) Radiation optic neuropathy. Ophthalmology 92:1118–1126

    PubMed  CAS  Google Scholar 

  40. Korvacs K, Horvath E (1986) Tumors of the pituitary gland. Atlas of tumor pathology, 2nd series, fascicle Armed Forces Institute of Pathology, Washington

    Google Scholar 

  41. Landolt AM, Lomax N (2000) Gamma knife radiosurgery for prolactinomas. J Neurosurg 93 (Suppl) 3:14–18

    Google Scholar 

  42. Laws ER Jr, Morris AM, Maartens N (2003) Gliadel for pituitary adenomas and craniopharyngiomas. Neurosurgery 53:255–260

    Article  PubMed  Google Scholar 

  43. Laws ER Jr, Thapar K (1999) Pituitary surgery. Endocrinol Metab Clin North Am 28:119–313

    Article  PubMed  Google Scholar 

  44. Leavens ME, McCutcheon IF, Samaan NA (1992) Management of pituitary adenomas. Oncology 6:69

    PubMed  CAS  Google Scholar 

  45. Liston SL, Siegel LG, Thienprasit P et al (1987) Nasal endoscopes in hypophysectomy. J Neurosurg 66:155

    PubMed  CAS  Google Scholar 

  46. Lindholm J (1992) Endocrine function in patients with Cushing’s disease before and after treatment. Clin Endocrinol 36:151–159

    Article  CAS  Google Scholar 

  47. Littley MD, Shalet SM, Reid H et al (1991) The effect of external pituitary irradiation on elevated serum prolactin levels in patients with pituitary macroadenomas. Q J Med 81:985

    PubMed  CAS  Google Scholar 

  48. Lubke D, Saeger W (1995) Carcinomas of the pituitary: definition and review of the literature. Gen Diagn Pathol 141:81

    PubMed  CAS  Google Scholar 

  49. Ludecke DK, Lutz BS, Niedworok G (1989) The choice of treatment after incomplete adenomectomy in acromegaly: Proton versus high-voltage radiation. Acta Neurochir 96:32–38

    Article  CAS  Google Scholar 

  50. McCollough WM, Marcus RB Jr, Rhoton AL Jr et al (1991) Long-term follow-up of radiotherapy for pituitary adenoma. The absence of late recurrence after ≥4,500 cGy. Int J Radiat Oncol Biol Phys 21:607–614

    PubMed  CAS  Google Scholar 

  51. McCord MW, Buatti JM, Fennell EM et al (1997) Radiotherapy for pituitary adenomas: Long-term outcome and sequelae. Int J Radiat Oncol Biol Phys 43:591–595

    Google Scholar 

  52. Milker-Zabel S, Debus J, Thilmann C et al (2001) Fractionated stereotactically guided radiotherapy and radiosurgery in the treatment of functional and nonfunctional adenomas of the pituitary gland. Int J Radiat Oncol Biol Phys 50:1279–1286

    PubMed  CAS  Google Scholar 

  53. Murayama M, Yasuda K, Minamori Y et al (1992) Longterm follow-up of Cushing’s disease treated with reserpine and pituitary irradiation. J Clin Endocrinol Metab 75:935–942

    Article  PubMed  CAS  Google Scholar 

  54. Newman CB (1999) Medical therapy for acromegaly. Endocrinol Metab Clin North Am 28:171–190

    Article  PubMed  CAS  Google Scholar 

  55. Petrovich Z, Jozsef G, Yu C et al (2003) Radiotherapy and stereotactic radiosurgery for pituitary tumors. Neurosurg Clin N Am 14:147–166

    Article  PubMed  Google Scholar 

  56. Petrovich Z, Yu C, Giannotta SL, Zee C-S et al (2003) Gamma knife radiosurgery for pituitary adenoma: early results. Neurosurgery 53:51–61

    Article  PubMed  Google Scholar 

  57. Plataniotis GA, Kouvaris JR, Vlahos L et al (1998) Radiation therapy alone for growth hormone-producing pituitary adenomas. Acta Oncol 37:97–99

    Article  PubMed  CAS  Google Scholar 

  58. Ross DA, Wilson CB (1988) Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas in a series of 214 patients. J Neurosurg 68:854–867

    PubMed  CAS  Google Scholar 

  59. Salinger DJ, Brady LW, Miyamoto CT (1992) Radiation therapy in the treatment of pituitary adenomas. Am J Clin Oncol (CCT) 15:467–473

    CAS  Google Scholar 

  60. Scheithauer BW, Kovacs KT, Laws ER et al (1986) Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg 65:733

    PubMed  CAS  Google Scholar 

  61. Sheehan JP, Kondziolka D, Flickinger J et al (2002) Radiosurgery for residual of recurrent nonfunctioning pituitary adenoma. J Neurosurg (Suppl 5) 97:408–414

    PubMed  Google Scholar 

  62. Shin M (2002) Section Pituitary gamma knife radiosurgery for pituitary adenoma. Biomed Pharmacother 56: 178S–181S

    Article  PubMed  Google Scholar 

  63. Stafford SL, Pollock BE, Leavitt JA et al (2003) A study of the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 55:1177–1181

    PubMed  Google Scholar 

  64. Trainer PJ, Drake WM, Katznelson L et al (2000) Treatment of acromegaly with the growth hormone receptor antagonist pegvisomant. N Engl J Med 342:1171–1177

    Article  PubMed  CAS  Google Scholar 

  65. Tsagarakis E, Grossman A, Plowman PN et al (1991) Megavoltage pituitary irradiation in the management of prolactinomas: long-term follow-up. Clin Endocrinol 34:399–406

    Article  CAS  Google Scholar 

  66. Tsang RW, Brierly JD, Panzarella T et al (1996) Role of radiation therapy in clinical hormonally-active pituitary adenomas. Radiother Oncol 41:45–53

    Article  PubMed  CAS  Google Scholar 

  67. Tsang RW, Brierly JD, Panzarella T et al (1994) Radiation therapy for pituitary adenoma: Treatment outcome and procnostic factors. Int J Radiat Oncol Biol Phys 30:557–565

    PubMed  CAS  Google Scholar 

  68. Tucker HSG, Grubb SR, Wigand JP et al (1980) The treatment of acromegaly by transsphenoidal surgery. Arch Intern Med 140:795–802

    Article  PubMed  CAS  Google Scholar 

  69. Vlahovitch B, Reynaud C, Rhiati J et al (1988) Treatment and recurrence in 135 pituitary adenomas. Acta Neurochir [Suppl] 42:120–123

    CAS  Google Scholar 

  70. Von Werder K (1985) Recent advances in the diagnosis and treatment of hyperprolactinemia. In: Imura H (ed) The pituitary gland. Raven Press, New York, pp 405–439

    Google Scholar 

  71. Webster J, Piscitelli G, Polli A et al (1994) Cabergoline comparative study group. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinaemic amenorrhoea. N Engl J Med 331:904–909

    Article  PubMed  CAS  Google Scholar 

  72. Weber T, Saeger W, Lüdecke DK (1987) Light microscopical morphometry, immunocytochemistry, and clinical correlations of pituitary adenomas at various stages of oncocytic transformation. Acta Endocrinol 116:489–496

    PubMed  CAS  Google Scholar 

  73. Werner S, Trampe E, Palacios P et al (1985) Growth hormone-producing pituitary adenomas with concomitant hypersecretion of prolactin are particulary sensitive to photon irradiation. Int J Radiat Oncol Biol Phys 11:1713–1720

    PubMed  CAS  Google Scholar 

  74. Yoon SC, Suh TS, Jang HS et al (1998) Clinical results of 24 pituitary macroadenomas with linac-based stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 41:849–853

    PubMed  CAS  Google Scholar 

  75. Zierhut D, Flentje F, Adolph J et al (1995) External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys 33:307–314

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology and Therapeutic Radiology, Klinikum Stadt Hanau, Leimenstr. 20, 63450, Hanau, Germany

    Dietmar Zierhut MD

Authors
  1. Dietmar Zierhut MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology and Therapeutic Radiology, Alfried-Krupp-Hospital, Alfried-Krupp-Strasse 21, Postfach 10 22 43, 45117, Essen, Germany

    Michael Heinrich Seegenschmiedt MD (Professor) (Professor)

  2. Strahlenklinik Klinikum Duisburg, Zu den Rehwiesen 9, 47055, Duisburg, Germany

    Hans-Bruno Makoski MD (Professor) (Professor)

  3. Department of Radiation Biology, St. Bartolomew’s Medical College, Charterhouse Square, London, EC1M 6BQ, UK

    Klaus-Rüdiger Trott MD (Professor) (Professor)

  4. Hylda Cohn/American Cancer Society, USA

    Luther W. Brady MD (Professor of Clinical Oncology, and Professor, Department of Radiation Oncology Distinguished University Professor) (Professor of Clinical Oncology, and Professor, Department of Radiation Oncology Distinguished University Professor)

  5. College of Medicine, Drexel University, Broad & Vine Sts., Mail Stop 200, Philadelphia, PA, 19102-1192, USA

    Luther W. Brady MD (Professor of Clinical Oncology, and Professor, Department of Radiation Oncology Distinguished University Professor) (Professor of Clinical Oncology, and Professor, Department of Radiation Oncology Distinguished University Professor)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Zierhut, D. (2008). Pituitary Adenoma. In: Seegenschmiedt, M.H., Makoski, HB., Trott, KR., Brady, L.W. (eds) Radiotherapy for Non-Malignant Disorders. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68943-0_37

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-68943-0_37

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-62550-6

  • Online ISBN: 978-3-540-68943-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation