From the Guidelines
The recommended treatment for a growing pituitary adenoma with symptoms of dizziness, headache, and loss of balance is transsphenoidal surgery, as it is a safe and effective procedure for removing the tumor while preserving normal pituitary function 1. This approach is supported by the most recent and highest quality study, which suggests that transsphenoidal surgery is the technique of choice for pituitary adenomas, even in patients with incompletely pneumatized sphenoid sinuses 1. The study also recommends considering endoscopic rather than microscopic transsphenoidal surgery for its potentially superior efficacy in preserving pituitary function 1. In addition to surgery, medical therapy may be used for patients who are poor surgical candidates, such as dopamine agonists for prolactinomas or somatostatin analogs for growth hormone-secreting adenomas 1. Radiation therapy serves as a third-line option when surgery and medication are ineffective, with a recommended total dose of 45-50.4 Gy in 1.8 Gy daily fractions 1. Immediate management should include corticosteroids to reduce inflammation and swelling around the tumor, with the goal of removing the tumor, normalizing hormone levels, relieving pressure on surrounding structures, and preserving normal pituitary function to resolve symptoms like dizziness, headaches, and balance problems. Some key points to consider in the treatment approach include:
- Tumor type, size, and hormone production
- Patient factors, such as age and overall health
- The need for a pituitary-specific multidisciplinary team (MDT) to provide optimal care and improve quality of life
- The importance of long-term surveillance and follow-up to monitor for potential complications and recurrence. It is essential to prioritize the patient's health-related quality of life and to consider the potential long-term sequelae of pituitary adenomas, which can be life-changing and life-limiting 1.
From the FDA Drug Label
Cabergoline tablets are indicated for the treatment of hyperprolactinemic disorders, either idiopathic or due to pituitary adenomas. The recommended treatment for a growing pituitary adenoma with symptoms of dizziness, headache, and loss of balance is cabergoline (PO), as it is indicated for the treatment of hyperprolactinemic disorders, either idiopathic or due to pituitary adenomas 2. Key considerations for treatment include:
- Using the lowest effective dose of cabergoline
- Periodically reassessing the need for continuing therapy with cabergoline
- Conducting clinical and diagnostic monitoring to assess the risk of cardiac valvulopathy 2.
From the Research
Pituitary Adenoma Treatment
The recommended treatment for a growing pituitary adenoma with symptoms of dizziness, headache, and loss of balance depends on the type of tumor.
- For prolactinomas, first-line therapy is usually medical therapy, either bromocriptine or cabergoline 3, 4, 5.
- For other pituitary adenomas, first-line therapy is usually transsphenoidal pituitary surgery 3, 4, 6.
- Patients with macroadenomas may require evaluation for hypopituitarism and those with tumors compressing the optic chiasm should be referred to an ophthalmologist for formal visual field testing 3.
- Treatment strategies and long-term follow-up should be discussed with the patient, and replacement of a deficient hormone or hormones is necessary for optimal functioning 6.
Treatment Options
Treatment options for pituitary adenomas include:
- Transsphenoidal surgery 3, 4, 6
- Medical therapies, such as dopamine agonists for prolactinomas 3, 4, 5
- Radiotherapy 4
- Replacement of a deficient hormone or hormones 6
- Medications to lower hormone hypersecretion to normal, such as somatostatin analogues, cabergoline, and pegvisomant for acromegaly 4, 5
Patient Management
Patients with pituitary adenomas should be identified at an early stage so that effective treatment can be implemented 4.
- A team approach to management, including endocrinology and neurosurgery, is recommended 7.
- Lifelong monitoring is necessary for all patients with pituitary adenomas 6.
- The goal of treatment is to decrease the mass effect of the adenoma, restore normal pituitary function, and suppress hormone hypersecretion 6.