Pituitary adenoma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

Pharmacologic medical therapy is recommended among patients with prolactinoma, thyrotrophic, somatotrophic and adrenocorticotropic 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.
• Clomifene is contraindicated in patient with Pituitary adenoma.