The treatment of pituitary adenoma mainly depends on the size of the tumor, whether it secretes hormones and the complications of the patient. The treatment of pituitary adenoma is a comprehensive treatment process of multi-department cooperation. The departments involved in the treatment of pituitary adenoma mainly include endocrinology, neurosurgery, radiotherapy, ophthalmology, imaging diagnosis and other departments. From the retrospective clinical data at home and abroad, it can be seen that the multi-disciplinary treatment center for pituitary adenoma is quite different from the pure specialist treatment center in improving the treatment effect of pituitary adenoma patients. Therefore, it is suggested that patients with pituitary adenoma should go to a medical center with comprehensive treatment for pituitary adenoma.
The treatment of pituitary adenoma mainly includes surgery, medicine and radiotherapy. It is precisely because there is no one method that can completely cure every kind of pituitary tumor, so all kinds of treatment methods have their own advantages and disadvantages. Individualized treatment plan should be made according to the size of pituitary tumor, hormone secretion, complications and diseases of patients, patients' age, whether they have fertility requirements and patients' economic situation.
As for radiotherapy, because pituitary adenoma is an adenoma, its sensitivity to radiotherapy is poor, and nearly 7-8% of patients suffer from pituitary dysfunction after radiotherapy, which reduces the quality of life of patients. Therefore, radiotherapy is only suitable for patients with residual surgery, intolerance to surgery, insensitivity to drugs, and inability to receive surgery or drug treatment due to diseases.
drug therapy in recent years, with the continuous improvement of the level of drug research and development, the drug treatment of hormone-secreting pituitary adenoma has made great progress.
For secretory tumors in pituitary prolactin, it is believed that more than 9% patients (whether microadenomas or macroadenomas) can control the PRL level with dopamine agonists (short-acting bromocriptine, long-acting cabergoline) to reduce the tumor volume. Only those prolactin tumor patients who are allergic or intolerant to this kind of drugs, and whose acute symptoms caused by tumor compression need emergency surgical decompression, or who are unwilling to accept surgical treatment, choose surgical treatment. During the treatment of bromocriptine, the dose of bromocriptine should be gradually increased until the serum PRL level drops to normal level, and the dose should be adjusted to maintain the treatment for a long time. For patients with fertility requirements, bromocriptine should be stopped after pregnancy. Check the visual field regularly during pregnancy until the treatment of bromocriptine is resumed after delivery. For patients who have miscarried or stillborn after stopping using bromocriptine after pregnancy, they should insist on taking the medicine until the dosage of bromocriptine is adjusted after delivery. A great deal of clinical experience has proved that the children born during the period of taking bromocriptine by pregnant women have not seen obvious deformity and mental retardation.
For growth hormone secreting pituitary adenoma, the main progress in recent 2 years is the application of somatostatin analogues. The clinical application of this drug has obviously improved the cure rate of GH secreting tumor. In recent years, long-acting preparations of somatostatin analogues, such as long-acting octreotide and somadulin, have been used in clinic, which greatly improves the compliance of patients. Preoperative application of this kind of drugs can quickly reduce the serum GH level of patients, alleviate the symptoms of patients, reduce the volume of tumors, and create good preoperative conditions for radical resection of tumors. Other indications of somatostatin analogues for GH-secreting tumors include: transitional treatment for postoperative residual patients and patients whose GH has not decreased to normal after radiotherapy. After the application of growth hormone analogues, patients with heart failure, respiratory sleep apnea, poor control of hyperglycemia and hypertension, and patients who can not tolerate anesthesia, are provided with opportunities for preoperative preparation and treatment. In foreign countries, because there is no need to worry about medical expenses, many patients who are unwilling to undergo surgery have been treated with somatostatin for a long time to control tumors, and satisfactory therapeutic results have been achieved. Somatostatin analogues have also achieved satisfactory therapeutic effects in thyroid-stimulating hormone-secreting tumors. After treating GH secreting pituitary adenoma with drugs, it has been recognized that the goal of biochemical cure is to reduce the GH level of patients with GH secreting pituitary adenoma to less than 1ng/dl (GH value after taking sugar) and to reduce the insulin-like growth factor (IGF-1) to the level of age-matched normal people. No matter what treatment patients with growth hormone secreting tumors receive, they should achieve the following therapeutic goals: eliminating tumors, reducing tumor recurrence, reaching GH standards, relieving clinical symptoms, preserving pituitary function as much as possible, improving patients' quality of life and prolonging patients' life.