John Wass

Guías de la Pituitary Society para el diagnóstico y tratamiento de los prolactinomas

aDepartamento de Medicina. División de Endocrinología. Universidad de Santiago de Compostela. Santiago de Compostela. A Coruña. España. bDivision of Endocrinology. Northwestern University. Chicago. Illinois. Estados Unidos. cDepartment of Internal Medicine. University of Iowa. Iowa City. Iowa. Estados Unidos. dDepartment of Endocrinology. Universitair Ziekenhuis. Antwerp. Bélgica. eDepartment of Medicine. Cedars Sinai Medical Center. University of California. Los Angeles. California. Estados Unidos. fNeuroendocrine Unit. University of São Paulo. São Paulo. Brasil. gDepartment of Endocrinology. Hôpital de la Timone. Université de la Méditerranée. Marsella. Francia. hDepartment of Neurological Sciences. Università Federico II. Nápoles. Italia. iDepartment of Endocrinology. Università Federico II. Nápoles. Italia. jDepartment of Neurosurgery. University Erlangen-Nuremberg. Erlangen. Alemania. kUnidad de Endocrinología. Hospital T. Álvarez. Buenos Aires. Argentina. lDepartment of Neurosurgery. Sheba Medical Center. Tel Aviv University. Tel Aviv. Israel. mINSERM U458. Hôpital Necker. París. Francia. nDepartment of Medicine. New York University. New York. Estados Unidos. ñDepartment of Neurosurgery. University of Virginia. Charlottesville. Virginia. Estados Unidos. oDepartment of Medicine. Charles University. Praga. República Checa. pDepartment of Medicine. University of Wales. Cardiff. Wales. Reino Unido. qDepartment of Endocrinology. Portuguese Cancer Institute. Lisboa. Portugal. rDepartment of Endocrinology. Churchil Hospital. Oxford. Reino Unido. sDepartment of Internal Medicine. Università di Brescia. Brescia. Italia.

Nonfunctioning and Gonadotrophin-Secreting Adenomas

Abstract As nonfunctioning pituitary tumors and gonadotrophin-secreting adenomas likely arise from a similar cell type, they are often indistinguishable. These tumors are the second most frequently occurring tumors of the pituitary. They may immunostain and/or secrete gonadotrophins as well as subunits thereof. Macroadenomas tend to enlarge in 50% of cases within 5 years of diagnosis. These are monoclonal tumors but the genetic basis is unclear. They may present incidentally or after some years with compression of the surrounding structures including visual field defects and headaches often associated with hypopituitarism. Treatment is with surgery usually using the transsphenoidal route. After imaging and biochemical postoperative assessment, the usual treatment is with regular follow-up and imaging extended over a period of years. Radiotherapy may be necessary in the presence of persistent extrasellar tumor postoperatively. Occasionally, these tumors present with more rapid growth but medical treatment with dopamine agonists or somatostatin receptor analogues is not usually useful. Temozolomide for aggressive tumors can be effective. Gonadotrophin-secreting pituitary tumors may present with specific characteristics, including hyperstimulation of the ovaries in women, enlargement of the testes in men, and isosexual precocious puberty in children. In general, the treatment is similar to that of nonfunctioning pituitary adenomas.