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.