Medical Therapy for Gonadotroph and Thyrotroph Tumors

Shomali, Mansur; Katznelson, Laurence

doi:10.1016/s0889-8529(05)70065-7

Cited by 28 publications

(26 citation statements)

References 95 publications

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“…Its influence on tumor growth appears to be less predictable and less common as minimal reductions in size were reported in fewer than 10-15% of treated patients. Until more experience is acquired using large numbers of patients, octreotide cannot be recommended for routine use (Shomali & Katznelson 1999).…”

Section: Medical Therapy Of Gonadotroph Adenomasmentioning

confidence: 99%

Pituitary tumors: pathophysiology, clinical manifestations and management.

Arafah¹,

Nasrallah²

2001

Endocrine-Related Cancer

185

141

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Pituitary tumors are frequently encountered intracranial neoplasms. They present with a variety of clinical manifestations that include symptoms and signs of excessive hormone secretion by the tumor, signs of hormone deficits by the normal pituitary gland and others related to expansion of the tumor mass and the resulting compression of surrounding structures such as the optic chiasm and cranial nerves. Advances in molecular biology, immunocytochemical staining and imaging, and the introduction of new treatment options have improved our understanding of the natural history of these adenomas and their management. Available treatments include surgical, medical and radiation therapy. Although the primary treatment for each tumor type may vary, it is important to consider all available options and select the most applicable for that patient. The interaction of all members of management team, including the primary care provider, the endocrinologist and the neurosurgeon in selecting the treatment course can only improve therapeutic outcome. Regardless of the initial choice of treatment, follow-up of all patients should be maintained indefinitely. The managing physician should be familiar with the natural history and long-term complications of pituitary adenomas, and with the side effects of treatments given over the years.

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Section: Medical Therapy Of Gonadotroph Adenomasmentioning

confidence: 99%

Pituitary tumors: pathophysiology, clinical manifestations and management.

Arafah¹,

Nasrallah²

2001

Endocrine-Related Cancer

185

141

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“…The most effective therapy is transsphenoidal resection of the pituitary tumor, which results in cure, improvement, or no change each in about one third of patients (25,26). External radiation and long-acting somatostatin analogs have been used (27)(28)(29). Treatment focused on the thyroid results in continued growth of the pituitary tumor.…”

Section: Excess Tshmentioning

confidence: 99%

Uncommon Causes of Thyrotoxicosis

Mittra¹,

Niederkohr²,

Rodríguez³

et al. 2008

J Nucl Med

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Apart from the common causes of thyrotoxicosis, such as Graves' disease and functioning nodular goiters, there are more than 20 less common causes of elevated free thyroid hormones that produce the symptoms and signs of thyrotoxicosis. This review describes these rarer conditions and includes 14 illustrative patients. Thyrotropin and free thyroxine should be measured and, when the latter is normal, the free triiodothyronine level should be obtained. Measurement of the uptake of 123 I is recommended for most patients.

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“…A distinção entre as duas condições pode ser difícil, especialmente se a imagem hipofisária for equívoca (71). Como opções terapêuticas para os TSH-omas temos a cirurgia transesfenoidal, a radioterapia e/ou o uso de drogas.…”

Section: Adenomas Secretores De Tshunclassified

“…É classicamente considerada a terapêutica inicial de escolha para os TSH-omas (66,(71)(72)(73). Entretanto, como eles geralmente são grandes -90% são macroadenomas (67) -e localmente invasivos, o percentual de cura (definida como normalização hormonal e retirada completa do adenoma) tem se revelado bastante insatisfatório, variando de 35 a 38% em três séries (66,72,73).…”

Section: Cirurgia Transesfenoidalunclassified

“…Há dados escassos sobre a eficácia dos DAs nos TSH-omas, com resultados geralmente insatisfatórios (52). Tal fato poderia resultar da limitada presença de receptores dopaminérgicos nesses tumores (71,75). Quando usada em 24 pacientes, a bromocriptina (20-60 mg/dia) normalizou a função tiroideana em apenas 2 (8,3%), sem modificação nos níveis de TSH (76,77).…”

Section: ) Agonistas Dopaminérgicos (Das)unclassified

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Tratamento medicamentoso dos tumores hipofisários. parte II: adenomas secretores de ACTH, TSH e adenomas clinicamente não-funcionantes

Vilar

Naves

Freitas

et al. 2000

Arq Bras Endocrinol Metab

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This article reviews the potencial role of medical treatment for both ACTH and TSH secreting pituitary adenomas, as well as for clinically non-functionning pituitary adenomas (CNFPA). Metyrapone, mitotane and ketoconazole (preferable for causing less side-effects) are the most effective drugs for the control of hypercortisolism but none of them surpasses the efficacy of transsphenoidal surgery (TSA). Drug therapy in Cushing's disease is therefore better indicated for patients waiting for the full effect of radiotherapy or, as an alternative to radiotherapy, for cases of TSA failure as well as patients that refuse or have clinical limitations to surgery. Other potential indications for medical treatment in Cushing's disease include elderly patients with microadenomas or small macroadenomas, as well as cases associated to an empty sella. Concerning TSH-secreting adenomas, somatostatin analogues (SRIFa) lead to normalization of thyroid hormones in up to 95% of treated patients. Therefore they may represent an useful tool for long-term treatment of such rare tumors in case of surgery failure or as primary therapy for selected cases. Occasionaly, dopamine agonists (DA), especially cabergoline, may also be efficacious in normalizing hormone levels. In contrast, DA and SRIFa rarely induce significant tumor shrinkage in patients with CNFPA. Thus, these drugs should be considered particularly for patients who are poor candidates for surgery or in whom surgery and radiotherapy have failed to control the disease. (Arq Bras Endocrinol Metab 2000;44/6: 455-470)

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Medical Therapy for Gonadotroph and Thyrotroph Tumors

Cited by 28 publications

References 95 publications

Pituitary tumors: pathophysiology, clinical manifestations and management.

Pituitary tumors: pathophysiology, clinical manifestations and management.

Uncommon Causes of Thyrotoxicosis

Tratamento medicamentoso dos tumores hipofisários. parte II: adenomas secretores de ACTH, TSH e adenomas clinicamente não-funcionantes

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