Pituitary adenoma medical therapy

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

Pharmacologic medical therapy is recommended among patients with prolactinoma, thyrotrophic, somatotrophic, and adrenocorticotropic adenomas.

Treatment options depend on the type of tumor and on its size:

• Prolactinomas are most often treated with dopamine agonists such as bromocriptine and cabergoline. The latter, decreases tumor size as well as alleviates symptoms. Dopamine agonists are followed by serial imaging to detect the recurrence. If the adenoma is large, treatment may include radiation therapy and surgery. 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.
• Recurrent macroadenoma can be treated with octreotide, a long-acting somatostatin analogue. This can result in both reduction of the size of the tumour and reduction in the serum levels of growth hormone.^[1]
• Clomifene is contraindicated in patient with pituitary adenoma.