Pituitary adenomas – where is the treatment heading at the beginning of the 21st century?


Authors: J. Marek
Authors‘ workplace: III. interní klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in: Vnitř Lék 2010; 56(7): 690-694
Category: 80th Birthday - Jaroslava Blahoše, MD, DrSc.

Overview

To treat pituitary adenomas, three modes of treatment are usually combined: neurosurgery, radiation and pharmacological. Prolactinomas are an exception with predominantly pharmacological management. Patients with acromegaly are usually diagnosed late and thus many neurosurgeries fail to completely remove the adenoma. Any residual tumour tissue is usually irradiated with the Leksell Gamma Knife, and dopamine agonists, somatostatine analogues or growth hormone receptor antagonists are used to normalize the hormonal hypersecretion until the complete effect of the radiation. The same surgical and Gamma Knife procedures are used in patients with the Cushing’s disease and TSH‑secreting adenomas. Ketoconazole, metyrapone and cabergoline are used until the radiation effect in the Cushing’s disease is complete, similarly, somatostatine analogues are used in TSH‑secreting adenomas. Nonfunctional adenomas are less responsive to pharmacological treatment. Proautophagic cytostatic temozolamide has been used in aggressive pituitary adenomas and carcinomas.

Key words:
pituitary adenomas – prolactinomas – acromegaly – Cushing’s diseases – TSH‑secreting adenomas – clinically non‑functional pituitary adenomas – treatment


Sources

1. Marek J. Hypofyzární adenomy dnes a zítra. Postgraduál Med 2008; 10 (Suppl 1): 39–41.

2. Melmed S, Colao A, Barkan A et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 2009; 94: 1509–1517.

3. Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of bio­chemical “cure”. Eur J Endocrinol 2005; 152: 379–387.

4. Petrossians P, Borges‑Martins L, Espinoza C et al. Gross total resection or debulking of pituitary adenomas improves hormonal control of acromegaly by somatostatin analogs. Eur J Endocrinol 2005; 152: 61–66.

5. Karavitaki N, Turner HE, Adams CB. Surgical debulking of pituitary macroadenomas causing acromegaly improves control by lanreotide. Clin Endocrinol (Oxf) 2008; 68: 970–975.

6. Vladyka V, Liščák R, Novotný J Jr et al. Radiation tolerance of functioning pituitary tissue in gamma knife surgery for pituitary adenomas. Neurosurgery 2003; 52: 309–317.

7. Ježková J, Marek J, Hána V et al. Gamma knife radiosurgery for acromegaly – long‑term experience. Clin Endocrinol 2006; 64: 588–595.

8. Abs R, Verhelst J, Maiter D et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab 1998; 83: 374–378.

9. Murray RD, Melmed S. A critical analysis of clinically available somatostatin analog formulations for therapy of acromegaly. J Clin Endocrinol Metab 2008; 93: 2957–2968.

10. Ashwell SG, Bevan JS, Edwards OM. The efficacy and safety of lanreotide Autogel in patients with acromegaly previously treated with octreotide LAR. Eur J Endocrinol 2004; 150: 473–480.

11. Mercado M, Borges F, Bouterfa H et al. A prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR (long‑acting repeatable octreotide) in the primary therapy of patients with acromegaly. Clin Endocrinol (Oxf) 2007; 66: 859–868.

12. Cozzi R, Attanasio R, Lodrini S et al. Cabergoline addition to depot somatostatin analogues in resistant acromegalic patients: efficacy and lack of predictive value of prolactin status. Clin Endocrinol (Oxf) 2004; 61: 209–215.

13. Selvarajah D, Webster J, Ross R et al. Effectiveness of adding dopamine agonist therapy to long‑acting somatostatin analogues in the management of acromegaly. Eur J Endocrinol 2005; 152: 569–574.

14. Giustina A, Bonadonna S, Bugari G et al. High‑dose intramuscular octreotide in patients with acromegaly inadequately controlled on conventional somatostatin analogue therapy: a randomised controlled trial. Eur J Endocrinol 2009; 161: 331–338.

15. Freda PU, Katznelson L, van der Lely AJ et al. Long‑acting somatostatin analog therapy of acromegaly: a meta‑analysis. J Clin Endocrinol Metab 2005; 90: 4465–4473.

16. Cozzi R, Montini M, Attanasio R et al. Primary treatment of acromegaly with octreotide LAR: a long‑term (up to nine years) prospective study of its efficacy in the control of disease activity and tumor shrinkage. J Clin Endocrinol Metab 2006; 91: 1397–1403.

17. Kopchick JJ, Parkinson C, Stevens EC et al. Growth hormone receptor antagonists: discovery, development, and use in patients with acromegaly. Endocr Rev 2002; 23: 623–646.

18. van der Lely AJ, Hutson RK, Trainer PJ et al. Long‑term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet 2001; 358: 1754–1759.

19. Brue T. Acrostudy: Status update on 469 patients. Horm Res 2009; 71 (Suppl 1): 34–38.

20. Colao A, Arnaldi G, Beck‑Peccoz P et al. Pegvisomant in acromegaly: why, when, how. J Endocrinol Invest 2007; 30: 693–699.

21. Buchfelder M, Weigel D, Droste M et al. Pituitary tumor size in acromegaly during pegvisomant treatment: experience from MR re‑evaluations of the German Pegvisomant Observational Study. Eur J Endocrinol 2009; 161: 27–35.

22. van der Lely AJ, Kopchick JJ. Growth hormone receptor antagonists. Neuroendocrinology 2006; 83: 264–268.

23. Parkinson C, Burman P, Messig M et al. Gender, body weight, disease activity, and previous radiotherapy influence the response to pegvisomant. J Clin Endocrinol Metab 2007; 92: 190–195.

24. Nomikos P. Modulation of radiation response by drugs in pituitary adenomas – latest information. Abstracts of the 15th International Meeting of the Leksell Gamma Knife Society. May 16–20. 2010, Athens, p. 82.

25. Ono M, Miki N, Kawamata T et al. Prospective study of high‑dose cabergoline treatment of prolactinomas in 150 patients. J Clin Endocrinol Metab 2008; 93: 4721–4727.

26. Ježková J, Hána V, Kršek M et al. Use of the Leksell gamma knife in the treatment of prolactinoma patients. Clin Endocrinol (Oxf) 2009; 70: 732–741.

27. Ježková J, Marek J. Diagnosis and treatment of prolactinomas. Expert Rev Endocrinol Metab 2009; 4: 135–142.

28. Molitch ME. Pregnancy and the hyperprolactinemic women. N Engl J Med 1985; 312: 1364–1370.

29. Krupp P, Monka C. Bromocriptine in pregnancy: safety aspects. Klin Wochenschr 1987; 65: 823–827.

30. Colao A, Abs R, Bárcena DG et al. Pregnancy outcomes following cabergoline treatment: extended results from a 12‑year observational study. Clin Endocrinol (Oxf) 2008; 68: 66–71.

31. Casanueva FF, Molitch ME, Schlechte JA et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) 2006; 65: 265–273.

32. Klibanski A. Clinical practice. Prolactinomas. N Engl J Med 2010; 362: 1219–1226.

33. Dekkers OM, Lagro J, Burman P et al. Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta‑analysis. J Clin Endocrinol Metab 2010; 95: 43–51.

34. Stewart PM, Petersenn S. Rationale for treatment and therapeutic options in Cushing’s disease. Best Pract Res Clin Endocrinol Metab 2009; 23 (Suppl 1): S15–S22.

35. Feelders RA, de Bruin C, Pereira AM et al. Pasireotide alone or with cabergoline and ketoconazole in Cushing‘s disease. N Engl J Med 2010; 362: 1846–1848.

36. Beck‑Peccoz P, Persani L, Mannavola D et al. Pituitary tumours: TSH‑secreting adenomas. Best Pract Res Clin Endocrinol Metab 2009; 23: 597–506.

37. Gabalec F, Čáp J. Klinicky afunkční adenomny hypofýzy – možnosti farmakologické léčby. DMEV 2009; 12: 94–98.

38. Liščák R, Vladyka V, Marek J et al. Gamma knife radiosurgery for endocrine‑inactive pituitary adenomas. Acta Neurochir (Wien) 2007; 149: 999–1006.

39. Peverelli E, Olgiati L, Locatelli M et al. The dopamine‑somatostatin chimeric compound BIM‑23A760 exerts antiproliferative and cytotoxic effects in human non‑functioning pituitary tumors by activating ERK ½ and p38 pathways. Cancer Lett 2010; 288: 170–176.

40. Neff LM, Weil M, Cole A et al. Temozolomide in the treatment of an invasive prolactinoma resistant to dopamine agonists. Pituitary 2007; 10: 81–86.

41. Syro LV, Scheithauer BW, Ortiz LD et al. Effect of temozolomide in a patient with recurring oncocytic gonadotrophic pituitary adenoma. Hormones (Athens) 2009; 8: 303–306.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 7

2010 Issue 7

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account