Recent Progress in the Medical Therapy of Pituitary Tumors

Abstract

Management of pituitary tumors is multidisciplinary, with medical therapy playing an increasingly important role. With the exception of prolactin-secreting tumors, surgery is still considered the first-line treatment for the majority of pituitary adenomas. However, medical/pharmacological therapy plays an important role in controlling hormone-producing pituitary adenomas, especially for patients with acromegaly and Cushing disease (CD). In the case of non-functioning pituitary adenomas (NFAs), pharmacological therapy plays a minor role, the main objective of which is to reduce tumor growth, but this role requires further studies. For pituitary carcinomas and atypical adenomas, medical therapy, including chemotherapy, acts as an adjuvant to surgery and radiation therapy, which is often required to control these aggressive tumors. In the last decade, knowledge about the pathophysiological mechanisms of various pituitary adenomas has increased, thus novel medical therapies that target specific pathways implicated in tumor synthesis and hormonal over secretion are now available. Advancement in patient selection and determination of prognostic factors has also helped to individualize therapy for patients with pituitary tumors. Improvements in biochemical and “tumor mass” disease control can positively affect patient quality of life, comorbidities and overall survival. In this review, the medical armamentarium for treating CD, acromegaly, prolactinomas, NFA, and carcinomas/aggressive atypical adenomas will be presented. Pharmacological therapies, including doses, mode of administration, efficacy, adverse effects, and use in special circumstances are provided. Medical therapies currently under clinical investigation are also briefly discussed.

Updates in Diagnosis and Treatment of Acromegaly

“…Pharmacologic agents available for treatment of acromegaly include somatostatin-receptor ligands, GH-receptor antagonists and, in selected cases, dopamine agonists ( Table 1 ). 57 The first-generation of SRLs, octreotide and lanreotide, have been the mainstay of medical treatment, 1 however, most recently pegvisomant (a genetically engineered, recombinant GH-receptor antagonist) has also been used as a first-line treatment. 58 , 59 Biochemical response and tumour reduction with SRLs varies widely between studies, from 20–70%, depending on the study design, history of surgical debulking and endpoint of the study itself (IGF-1, GH or composite GH and IGF-1).…”

Aggressive and malignant pituitary tumours: state-of-the-art

“…They recommend standard medical treatment with maximally tolerated doses in order to control tumour growth (R 3.3.1). Current reviews on the medical therapy of pituitary tumours summarised all the agents available these days to treat functioning tumours (Langlois et al 2017). In non-functioning tumours, radiotherapy was recommended in cases with clinically relevant tumour growth despite surgery, whereas for functioning tumours, it was recommended after surgery and standard medical treatment (R 3.2.1, ++00).…”

Updates in the Medical Treatment of Pituitary Adenomas

“…Of note, long-term CAB high dose may cause clinical valvular disease (as shown in patients with Parkinson's disease), and the risk should be taken into consideration for some patients [9,21,26]. Although occurrence of a clinically significant valvular disease was reassuringly low in large series of patients with prolactinomas treated with DAs [4,9,27], some groups recommend periodical follow-up of high risk patients, notably those taking high doses (e. g., > 3 mg/week) or high cumulative doses, with annual cardiovascular exam and, if necessary, echocardiogram (e. g., when a new cardiac murmur, edema, dyspnea, or cardiac failure occur) [28,29].…”