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Functioning Adenomas

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Oncology of CNS Tumors

Abstract

Pituitary adenomas with clinically relevant hypersecretion comprise approximately 40% of all pituitary adenomas. The most frequent is the prolactinoma. For more than 30 years this tumor has been regularly treated primarily by dopamine agonists. Thus, mostly tumor shrinkage and normalization of prolactin plasma levels have been achieved. Intolerance and partial effi-cacy are indications for a surgical approach. A parallel comparison of medically pretreated and only surgically treated patients showed significant differences that are of importance to the surgeon and pathologist. In acromegaly, specific medications with somatostatin analogues became available more than 20 years ago. In most cases with or, increasingly rarely, without pre-treatment, transnasal microsurgery is performed with the option of long-lasting clinical remission. In incompletely resectable adenomas, the discussed indication for surgery involves improvement of the effects of medical treatment and reduction of the radiation field. New pharmaceutical approaches with a GH-receptor antagonist optionally in combination with somatostatin analogues and or dopamine-agonists challenge the surgical options. TSH-secreting adenomas are extremely rare and may also be successfully treated by soma-tostatin analogues. After shrinkage or without gross invasion and improved microsurgical techniques, longterm results are promising. All these adenomas have tumor markers with a short half-life in plasma and may be checked during or shortly after surgery. Pretreatments influence the assessment, which has to be taken into consideration. In Cushing's disease, measurement of ACTH and cortisol the day after surgery mostly clarifies the effect of surgery. In selected primary failures, early re-operation may be successfully performed. Nowadays, the diagnosis (late-night cortisol, CRH test) and follow-up can easily be done with salivary cortisol. Medical options with more adenoma-specific ligands (Pasireotide) are under clinical evaluation.

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Acknowledgments

We thank Mrs. H.P. Flitsch for her assistance with the English language of 13.5 and Ass. Prof. P. A. Crock for proofreading

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Authors and Affiliations

  1. Neurochirurgische Klinik, Universitätskrankenhaus, Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany

    Dieter K. Lüdecke & Jörg Flitsch

  2. Department of Neurosurgery, Showa University, School of Medicine, 1-5-8 Hatanodai, Shinagawa-K, Tokyo, 1428666, Japan

    Takumi Abe

  3. ENDOC Center for Endocrine Tumors, Altonaer Strasse 59, Hamburg, 20357, Germany

    Stephan Petersenn

  4. Department of Pathology, Marienkrankenhaus, Alfredstrasse 9, Hamburg, 22087, Germany

    Wolfgang Saeger

Authors
  1. Dieter K. Lüdecke
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  2. Takumi Abe
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  3. Jörg Flitsch
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  4. Stephan Petersenn
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  5. Wolfgang Saeger
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Corresponding author

Correspondence to Dieter K. Lüdecke .

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Editors and Affiliations

  1. Universitätsklinikum München Klinikum Großhadern Neurochirurgische Klinik, Marchioninistr. 15, München, 81377, Germany

    Jörg-Christian Tonn

  2. Universitätsklinikum Hamburg Krankenhaus Eppendorf Klinik und Poliklinik für Neurochirurgie, Martinistr. 52, Neurologie, Hamburg, 20246, Germany

    Manfred Westphal

  3. Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue Suite 1502, Toronto, ON, M5G 1X8, Canada

    James T. Rutka

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Lüdecke, D.K., Abe, T., Flitsch, J., Petersenn, S., Saeger, W. (2010). Functioning Adenomas. In: Tonn, JC., Westphal, M., Rutka, J.T. (eds) Oncology of CNS Tumors. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02874-8_13

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  • DOI: https://doi.org/10.1007/978-3-642-02874-8_13

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-02873-1

  • Online ISBN: 978-3-642-02874-8

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