"Radiosurgery is also occasionally used. Its main complication is hypopituitarism (seen in 21–50%% of cases). Less common complications include damage to the optic apparatus (optic nerves, chiasm, optic tracts), cranial nerves, and internal carotid arteries 7."
Expected headings
"Hormone imbalance"
"Mass effect"
"Associations"
"Surgical management"
"Medical management"
"Stereotactic radiosurgery"
"Prognosis"
"Pituitary adenomas and pituitary carcinomas are, in fact, neuroendocrine tumours and should be referred to as pituitary neuroendocrine tumours (PitNET). Gradually, terminology is shifting to reflect this. Indeed, in the 5th editions of the WHO classification of CNS tumours (2021) and WHO classification of endocrine and neuroendocrine tumours (2025), "PitNET" has been added to pituitary adenoma (rather than replacing it) 12,13."
"Pituitary adenomas are common, with rates varying widely depending on the definition: population prevalence is approximately 0.1%; autopsy prevalence is around 15% 15,18. They account for approximately 10% of all intracranial neoplasms and 30-50% of all pituitary region masses 3."
"non-secretory: ~35%; most tend to be macroadenomas"
"It is also important to note that larger tumours can lead to hormonal imbalance due to mass effect rather than secretion. Hypopituitarism or moderately elevated prolactin are both seen, the latter due to the so-called stalk effect; prolactin release (unlike other pituitary hormones) is tonically inhibited by prolactin inhibitory hormones (PIH), most significantly dopamine, and as such, compression of the pituitary infundibulum can result in elevation of systemic prolactin levels due to interruption of normal inhibition. Keep in mind, though, that numerous drugs that act as dopamine antagonists will also elevate prolactin - see elevated prolactin (differential) 9."
"Growth hormone-secreting tumours are usually surgically resected; however, in recurrent cases or in patients who are not able to undergo surgery, they can be treated with octreotide (a long-acting somatostatin analogue). This can result in both reduction of the size of the tumour and reduction in the serum levels of growth hormone 4,5."
"Among clinically diagnosed pituitary adenomas presenting to medical attention, macroadenomas are more commonly identified than microadenomas 3 due to their tendency to cause symptoms from mass effect or hormonal dysfunction. However, when considering all adenomas, including those that are identified incidentally, autopsy and radiological studies demonstrate that microadenomas are far more prevalent in the general population, with microadenomas found in ~10% of autopsy studies compared to"
"There is usually no need for immediate treatment of patients with truly asymptomatic and non-functioning microadenomas. Even in the setting of prolactin secretion, in the absence of symptoms such as hypogonadism, amenorrhoea, infertility or bothersome galactorrhoea, these lesions can be managed with clinical, biochemical and imaging surveillance. Treatment should be instituted if symptoms develop, fertility is desired, or there is evidence of tumour progression 16."
"There is usually no need for immediate treatment of patients with truly asymptomatic and non-functioning microadenomas. Even in the setting of prolactin secretion, in the absence of symptoms such as hypogonadism, amenorrhoea, infertility or bothersome galactorrhoea, these lesions can be managed with clinical, biochemical and imaging surveillance. Treatment should be instituted if symptoms develop, fertility is desired, or there is evidence of tumour progression 16."
"Very rarely, pituitary adenomas may be seen in ectopic (i.e. extrasellar) locations, most commonly within the suprasellar region or within the sphenoid sinus. They may also be found in the cavernous sinus, parasellar region/middle cranial fossa, clivus, nasal cavity, nasopharynx, temporal bone, and third ventricle 10."
"There is usually no need for immediate treatment of patients with truly asymptomatic and non-functioning microadenomas. Even in the setting of prolactin secretion, in the absence of symptoms such as hypogonadism, amenorrhoea, infertility or bothersome galactorrhoea, these lesions can be managed with clinical, biochemical and imaging surveillance. Treatment should be instituted if symptoms develop, fertility is desired, or there is evidence of tumour progression 16."
"The most commonly employed approach to pituitary masses is transsphenoidal, whereby the floor of the pituitary fossa is accessed via the nasal cavity. In large tumours, other approaches may be necessary (e.g. craniotomy)."