Functioning adenomas

Abstract

Pituitary adenomas with clinically relevant hypersecretion comprise approximately 40% of all pituitary adenomas. The most frequent is the prolactinoma, which for 25 years has mostly been treated primarily by dopamine agonists. A parallel comparison of pretreated and only surgically treated patients showed significant differences which are of importance to the surgeon and pathologist. In acromegaly, specific medications with somatostatin analogues became available 20 years ago. In most cases with or, more and more rarely, without pretreatment, trans-nasal microsurgery is performed with the option of a long-lasting clinical remission. In incompletely resectable adenomas, the discussed indication for surgery lies in the reduction of the radiation field. New pharmaceutical methods challenge the surgical options. Thyrotropinomas are extremely rare and may also be successfully treated by somatostatin analogues. All these adenomas have tumor markers with a short half-life in plasma and may be checked during or shortly after surgery. In Cushing's disease, measurement of ACTH and Cortisol the day after surgery mostly clarifies the effect of surgery. Nowadays, the diagnosis and follow-up of Cushing's disease can easily be done with just saliva Cortisol. These active adenomas have in common that the results of different treatment options can be compared by exact criteria. Less than 1 mm functioning adenoma which is far beyond the sensitivity of the best MRI may produce the full clinical syndrome. The diagnostic and therapeutic approaches are so different that these adenomas can be described only separately. © Springer-Verlag Berlin Heidelberg 2006.