EM1712E "Pituitary Tumors: More Common Than You Think" (IM GR-120117)
Purpose: To provide the listener with an update on the manifestations and treatment of pituitary tumors
Overview: Pituitary adenomas affect 1 in 1420 adults, with about one-half being microadenomas (< 1 cm diameter) and the remainder are macroadenomas (> 1 cm). Mass effects, include headache, hypopituitarism, visual field defects and ophthalmoplegias. Treatments vary by tumor type and include transsphenoidal surgery, medical therapies and radiotherapy. Prolactinomas account for 49% of pituitary adenomas and present with reproductive dysfunction and galactorrhea and are generally treated with the dopamine agonists cabergoline and bromocriptine. Acromegaly accounts for 11% of pituitary tumors and usually presents with enlargement of the lips, tongue, nose, hands and feet and is diagnosed by finding elevated IGF-1 levels and growth hormone levels that are not suppressible by hyperglycemia. Initial treatment is surgery and medical therapy with somatostatin analogues, cabergoline, and pegvisomant, a growth hormone receptor antagonist, is often needed. Cushing’s disease accounts for 4% of pituitary adenomas and is associated with obesity, hypertension, diabetes and other morbidity. Measurement of a late night salivary cortisol is the best screening test but petrosal sinus sampling for ACTH may be necessary to distinguish a pituitary from an ectopic source. The primary treatment of Cushing’s disease is adenoma resection and medical therapies include ketoconazole, mifepristone and pasireotide. Nonsecreting tumors account for 34% of pituitary adenomas and present with mass effects; surgery is generally required, although incidentally found tumors can be followed if they are asymptomatic. Hyperthyroidism due to TSH-secreting tumors accounts for 1% of tumors and is treated with surgery and adjunctive somatostatin analogues if not surgically cured.
UT Southwestern faculty, fellows, residents and medical students, community physicians, nurse clinicians, physician assistants and nurses.
At the conclusion of this activity, the participant should be able to:
- List at least two advantages of cabergoline over bromocriptine in the treatment of patients with prolactinomas.
- List 3 possible complications of transsphenoidal surgery for pituitary tumors.
- Describe 3 possible complications of radiotherapy of pituitary tumors.
- List 3 medications used to treat acromegaly.
- List 3 medications used to treat Cushing’s disease.
Mark E. Molitch, M.D.
Martha Leland Sherwin Professor
Professor of Medicine Northwestern Medical Group – Chicago, IL
Visiting Professor for Division of Endocrinology
- 1.00 AMA