Effect of Hormone Levels and Aging on Cognitive Function of Patients with Pituitary Adenomas Prior to Medical Treatment

Object. The authors sought to evaluate the effect of gamma knife radiosurgery (GKS) on growth hormone (GH)—producing pituitary adenoma growth and endocrinological response. Methods. From 1993 to 1997, 79 patients with GH-producing pituitary adenomas were treated with GKS. Seventysix patients had acromegaly. Sixty-eight patients were treated with GKS as the primary procedure. The tumor margin was covered with a 50 to 90% isodose and the margin dose was 18 to 35 Gy (mean 31.3 Gy). The dose to the visual pathways was less than 10 Gy except in one case. Sixty-eight patients (86%) were followed for 6 to 52 months. Growth hormone levels declined with improvement in acromegaly in all cases in the first 6 months after GKS. Normalization of the hormone levels was achieved in 23 (40%) of 58 patients who had been followed for 12 months and in 96% of cases for more than 24 months (43 of 45), or more than 36 months (25 of 26), respectively. With the reduction of GH hormone levels, 12 of 21 patients with hyperglycemia regained a normal blood glucose level (p < 0.001). The tumor shrank in 30 (52%) of 58 patients who had been followed for 12 months (p < 0.01), 39 (87%) of 45 patients for more than 2 years (p = 0.02), and 24 (92%) of 26 patients for more than 36 months. In the remainder of patients tumor growth ceased. Conclusions. Gamma knife radiosurgery for GH-producing adenomas showed promising results both in hormonal control and tumor shrinkage. A margin dose of more than 30 Gy would seem to be effective in improving the clinical status, reducing high blood glucose levels, and normalizing hypertension.

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Salvage therapy with temozolomide in patients with aggressive or metastatic pituitary adenomas: experience in six cases

Acta Endocrinologica ◽

10.1530/eje-10-0629 ◽

2010 ◽

Vol 163 (6) ◽

pp. 843-851 ◽

Cited By ~ 64

Author(s):

Marco Losa ◽

Elena Mazza ◽

Maria Rosa Terreni ◽

Ann McCormack ◽

Anthony J Gill ◽

...

Keyword(s):

Pituitary Adenoma ◽

Tumor Size ◽

Pituitary Adenomas ◽

Dna Methyltransferase ◽

Response Assessment ◽

Pituitary Carcinoma ◽

Consecutive Series ◽

Positive Staining ◽

Hormone Levels ◽

Wide Range

ObjectiveThe prognosis of either pituitary carcinoma or aggressive pituitary adenoma resistant to standard therapies is poor. We assessed the efficacy of treatment with temozolomide, an oral second-generation alkylating agent, in a consecutive series of six patients with aggressive pituitary adenomas.DesignThis was a 1-year prospective study of temozolomide therapy in six consecutive patients with pituitary carcinoma (one case) or atypical pituitary adenoma (five cases) resistant to standard therapies. There were three males and three females. Age at enrollment ranged between 52 and 64 years. Temozolomide was given orally at a dose of 150–200 mg/m2 per day for 5 days every 4 weeks for a maximum of 12 cycles.MethodsResponse assessment was based on measurable change in tumor size, as assessed on magnetic resonance imaging, and hormone levels. Response was defined as reduction of at least 50% of tumor size and hormone levels.ResultsFour patients completed the 12 cycles of temozolomide treatment, as planned. Two patients stopped the drug after 3 and 6 months respectively because of the progression of disease. Two patients responded to temozolomide, while the remaining two patients had stable disease. Immunohistochemistry for O6-methylguanine-DNA methyltransferase (MGMT) in tumor sample showed a partial association with treatment response.ConclusionsTemozolomide treatment has a wide range of efficacy in patients with pituitary carcinoma or locally aggressive pituitary adenoma. Positive staining for MGMT seems likely to predict a lower chance of response.

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Updates in the Medical Treatment of Pituitary Adenomas

Hormone and Metabolic Research ◽

10.1055/a-1066-4592 ◽

2019 ◽

Vol 52 (01) ◽

pp. 8-24 ◽

Cited By ~ 6

Author(s):

Monica Livia Gheorghiu ◽

Francesca Negreanu ◽

Maria Fleseriu

Keyword(s):

Medical Treatment ◽

Cushing’S Disease ◽

Pituitary Adenomas ◽

Cellular Proliferation ◽

Somatostatin Receptor ◽

Phase Iii ◽

Cushing's Disease ◽

Clinical Effects ◽

Negative Results ◽

Somatostatin Receptor Ligands

AbstractPituitary adenomas represent approximately 15% of brain tumors; incidence is significantly on the increase due to widespread use of magnetic resonance imaging. Surgery remains the first-line treatment for most tumors overall. The role of dopaminergic agonists (DAs) and somatostatin receptor ligands (SRLs) in the treatment of pituitary adenomas is quite well established for prolactinomas and growth hormone (GH) excess. However, over the last decade new multi-receptor binding SRLs are increasingly used for treatment of acromegaly and Cushing’s disease. SRLs/DA chimeric compounds seem to have enhanced potency and efficacy when compared to that of individual SRLs or DA receptor agonists according to preclinical data. However, following negative results, more research is needed to determine if this interesting mechanism will translate into positive clinical effects for acromegaly patients. Furthermore, new agents that block adrenal steroidogenesis have been developed in phase III clinical trials for Cushing’s disease and several new compounds working at the pituitary level and/or blocking the glucocorticoid receptor are also in development. Combination therapy of drugs with similar or different mechanisms (possibly synergistic) are also on the increase. A growing awareness regarding all mechanisms involved in both control of pituitary secretion and cellular proliferation might allow for sole medical treatment of pituitary adenomas, especially macroadenomas, rather than surgery and/or radiation therapy, in the future. Moreover, the underlying decision on how to treat patients with pituitary adenomas should be individualized on a case-by-case basis with not only a goal of tumor shrinkage and biochemical control, but also of improving patients’ quality of life.

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