Editorials

Management of pituitary tumours

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7193.1226 (Published 08 May 1999) Cite this as: BMJ 1999;318:1226

Importance of multidisciplinary teams in regional centres

  1. John S Bevan, Consultant endocrinologist
  1. Aberdeen Royal Infirmary, Aberdeen AB25 2ZN

    Some physicians believe the management of pituitary tumours to be straightforward and non-controversial. Prolactinomas of all sizes should receive medical treatment with a dopamine agonist; large lesions producing optic chiasmal compression usually need surgical decompression and radiotherapy; and hypopituitarism can be treated with standard hydrocortisone, thyroxine, and sex steroid replacement therapy. Though there is a measure of truth in these statements, the modern management of pituitary disease is far more complicated.

    For instance, some patients with pituitary mass lesions and significant hyperprolactinaemia do not have prolactinomas but, instead, have functionless pituitary adenomas producing “stalk pressure” increases in prolactin concentration. Such patients require surgical rather than medical decompression.1 Furthermore, there is now a choice of several different dopamine agonists—the newer drugs cabergoline and quinagolide may have significant advantages over the reference compound, bromocriptine.2 Radiotherapy is not given automatically to all patients after surgical treatment of large pituitary tumours. Instead, selected patients may be followed postoperatively by using interval magnetic resonance imaging.3

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