From the Guidelines
Pituitary adenomas in children and young people (CYP) should be managed by a multidisciplinary team, with treatment tailored to the specific type of adenoma, its size, and the patient's symptoms. For prolactinomas, dopamine agonists like cabergoline are the first-line treatment, starting at a low dose (0.25 mg twice weekly) and gradually increasing as needed 1. For growth hormone-secreting adenomas causing acromegaly, somatostatin analogs like octreotide may be used, with a dose range of 100-500 mcg subcutaneously three times daily or 20-40 mg long-acting monthly 1.
Key Considerations
- Regular monitoring of hormone levels and MRI imaging is essential for all patients with pituitary adenomas 1.
- Transsphenoidal surgery is the standard approach for larger adenomas causing visual disturbances or other compression symptoms 1.
- Radiation therapy may be used for residual or recurrent tumors, with a recommended total dose of 45-50.4 Gy in 1.8 Gy daily fractions 1.
- Management of hormone deficiencies resulting from the tumor or its treatment is crucial to prevent long-term complications like vision loss, hormonal imbalances, and growth abnormalities 1.
Treatment Options
- Dopamine agonists (e.g., cabergoline, bromocriptine) for prolactinomas 1.
- Somatostatin analogs (e.g., octreotide) for growth hormone-secreting adenomas 1.
- Surgery (transsphenoidal) for larger adenomas or those causing compression symptoms 1.
- Radiation therapy for residual or recurrent tumors 1.
Important Recommendations
- Offer radiotherapy when the tumor is symptomatic, growing, resistant to medical therapy, and surgically inaccessible 1.
- Consider clinical radiation treatment protocols for CYP according to adult guidelines or pediatric regimens for similarly located tumors 1.
- Use highly conformal radiotherapeutic techniques, such as intensity-modulated radiation therapy or proton beam therapy, to minimize radiation exposure to surrounding normal tissue 1.
From the FDA Drug Label
Bromocriptine mesylate tablets, USP treatment is indicated in patients with prolactin-secreting adenomas, which may be the basic underlying endocrinopathy contributing to the above clinical presentations. Reduction in tumor size has been demonstrated in both male and female patients with macroadenomas In cases where adenectomy is elected, a course of bromocriptine mesylate tablets, USP therapy may be used to reduce the tumor mass prior to surgery.
Bromocriptine mesylate tablets, USP are indicated for the treatment of prolactin-secreting adenomas, which are a type of pituitary adenoma. The treatment can help reduce tumor size in patients with macroadenomas. Additionally, bromocriptine mesylate tablets, USP can be used to reduce tumor mass before surgery in cases where adenectomy is chosen 2.
- Key points:
- Indicated for prolactin-secreting adenomas
- Reduces tumor size in macroadenomas
- Can be used before adenectomy to reduce tumor mass
From the Research
Definition and Classification of Pituitary Adenomas
- Pituitary adenomas are neoplasms of the pituitary adenohypophyseal cell lineage and include functioning tumors, characterized by the secretion of pituitary hormones, and nonfunctioning tumors 3.
- They are classified as either macroadenomas (≥10 mm) or microadenomas (<10 mm) 3, 4.
Prevalence and Clinical Manifestations
- Clinically evident pituitary adenomas occur in approximately 1 in 1100 persons 3.
- Pituitary adenomas may cause mass effects, such as visual field defects, headache, and/or hypopituitarism 3, 4.
- Functioning tumors are those that produce an excess of normally produced hormones and include prolactinomas, somatotropinomas, corticotropinomas, and thyrotropinomas 3.
Diagnosis and Treatment
- All patients with pituitary tumors require endocrine evaluation for hormone hypersecretion 3.
- First-line therapy for prolactinomas consists of bromocriptine or cabergoline, and transsphenoidal pituitary surgery is first-line therapy for other pituitary adenomas requiring treatment 3, 4.
- Dopamine agonist therapy is the primary therapy for prolactin-secreting adenomas and usually results in normoprolactinemia, eugonadism, and tumor reduction 5.
Types of Pituitary Adenomas
- Prolactinomas account for 32% to 66% of adenomas and present with amenorrhea, loss of libido, galactorrhea, and infertility in women and loss of libido, erectile dysfunction, and infertility in men 4.
- Somatotropinomas account for 8% to 16% of tumors and usually present with enlargement of the lips, tongue, nose, hands, and feet 4.
- Corticotropinomas account for 2% to 6% of adenomas and are associated with obesity, hypertension, diabetes, and other morbidity 4.