Pituitary adenoma medical therapy: Difference between revisions
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* '''[[Prolactinoma]]s''' are most often treated with [[bromocriptine]] or more recently, [[cabergoline]] which, unlike bromocriptine, decreases tumor size as well as alleviates symptoms, both dopamine agonists, and followed by serial imaging to detect any increase in size. Treatment where the tumor is large can be with [[radiation therapy]] or surgery, and patients generally respond well. Efforts have been made to use a progesterone [[antagonist]] for the treatment of prolactinomas, but so far have not proved successful. | * '''[[Prolactinoma]]s''' are most often treated with [[bromocriptine]] or more recently, [[cabergoline]] which, unlike bromocriptine, decreases tumor size as well as alleviates symptoms, both dopamine agonists, and followed by serial imaging to detect any increase in size. Treatment where the tumor is large can be with [[radiation therapy]] or surgery, and patients generally respond well. Efforts have been made to use a progesterone [[antagonist]] for the treatment of prolactinomas, but so far have not proved successful. | ||
* '''Thyrotrophic adenomas''' respond to [[Somatostatin|octreotide, a long-acting somatostatin analog]], in many but not all cases according to a review of the medical literature. Unlike prolactinomas, thyrotrophic adenomas characteristically respond poorly to dopamine agonist treatment. | * '''Thyrotrophic adenomas''' respond to [[Somatostatin|octreotide, a long-acting somatostatin analog]], in many but not all cases according to a review of the medical literature. Unlike prolactinomas, thyrotrophic adenomas characteristically respond poorly to dopamine agonist treatment. | ||
*'''Somatotrophic adenomas''' can be treated with [[somatostatin analogues]], [[dopamine analogues]], and the newer GH-receptor antagonists, such as [[pegvisomant]]. | |||
*''' Adrenocorticotropic adenomas''' can be treated with [[ketoconazole]], an inhibitor of [[steroidogenesis]], it's considered as a drug of choice in adjunctive medical therapy for ACTH-producing adenomas. | |||
*Pituitary adenoma is considered an absolute contraindication to the use of [[clomifene]]. | *Pituitary adenoma is considered an absolute contraindication to the use of [[clomifene]]. | ||
Revision as of 15:42, 28 September 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pharmacologic medical therapy is recommended among patients with prolactinoma, thyrotophic adenomas and gonadorophic adenomas.
Medical Therapy
Treatment options depend on the type of tumor and on its size:
- Prolactinomas are most often treated with bromocriptine or more recently, cabergoline which, unlike bromocriptine, decreases tumor size as well as alleviates symptoms, both dopamine agonists, and followed by serial imaging to detect any increase in size. Treatment where the tumor is large can be with radiation therapy or surgery, and patients generally respond well. Efforts have been made to use a progesterone antagonist for the treatment of prolactinomas, but so far have not proved successful.
- Thyrotrophic adenomas respond to octreotide, a long-acting somatostatin analog, in many but not all cases according to a review of the medical literature. Unlike prolactinomas, thyrotrophic adenomas characteristically respond poorly to dopamine agonist treatment.
- Somatotrophic adenomas can be treated with somatostatin analogues, dopamine analogues, and the newer GH-receptor antagonists, such as pegvisomant.
- Adrenocorticotropic adenomas can be treated with ketoconazole, an inhibitor of steroidogenesis, it's considered as a drug of choice in adjunctive medical therapy for ACTH-producing adenomas.
- Pituitary adenoma is considered an absolute contraindication to the use of clomifene.