Provided by neurosurgery expert network Consultation number: 13188873256 Microsurgical excision of pituitary tumor via single nostril approach. Schematic diagram Concept of pituitary microadenoma by Xueming Lu, Department of Neurosurgery, Jinan Military General Hospital: Clinically, pituitary tumors ≤10mm in diameter are called pituitary microadenomas, and the diagnosis is mostly determined by imaging (CT or MRI) (pituitary tumors >10mm in diameter are called pituitary macroadenomas). Some pituitary microadenomas are found incidentally during CT or MRI of the head for other reasons, and the patient does not have any clinical symptoms of pituitary tumor and the endocrinological examination of pituitary gland is completely normal. For symptomatic pituitary microadenomas (mostly endocrinologic symptoms with headache; pituitary microadenomas with visual effects are rare), patients, their families and clinicians should pay high attention to them, which does not mean immediate surgery, but different treatment according to the patient’s situation. Management strategy of pituitary microadenoma: First, the clinical presentation of the patient combined with pituitary endocrinology and pituitary imaging can mostly determine the type of pituitary microadenoma, such as prolactin microadenoma, GH microadenoma, ACTH microadenoma or microadenoma with no obvious effect on secretory function (only headache, or mild menstrual disorder in young women). Prolactin (PRL) microadenoma: 1. Preferred drug treatment. For infertile women with pituitary prolactin microadenoma, oral treatment with dopamine agonist DD oligocryptine is generally available. 70% of women are able to get pregnant after 2 months as reported in the literature. With long-term treatment, the tumor size can be reduced and some patients can be cured. In young women who become pregnant after treatment with dopamine agonists, stroke or significant enlargement of the pituitary adenoma may occur during pregnancy, requiring emergency surgery if necessary. Long-term use of olfactantin, some patients have difficulty in adhering to it due to heavy side effects, in which case surgery is also an option.2. Transsphenoidal sinus surgery. Surgery is the most fundamental treatment for patients who are drug intolerant or dopamine agonist resistant. The success of surgery depends critically on the experience of the operator, the size and aggressiveness of the tumor. 60% to 90% of patients achieve normal prolactin levels after surgery. Therefore, it is reasonable for patients to choose surgical treatment. The most important prerequisite, of course, is the low mortality rate of transsphenoidal surgery and the low chance that the surgery will affect normal pituitary function, the latter being very important for patients who want to have children. It is worth noting that long-term treatment with dopamine agonists may affect the efficacy of the procedure. The introduction of endoscopic techniques into transsphenoidal surgery results in less trauma, almost no damage to the nasal cavity, better intraoperative visualization, more complete tumor removal, better protection of the normal pituitary gland, faster patient recovery, more comfort during recovery, and better surgical outcomes.3. Follow-up observation. Longitudinal studies have shown that only 7% of prolactin microadenomas can develop into larger tumor lesions. Therefore, for patients with prolactin microadenomas, if they have normal menstrual cycles and libido, and if they have mild overflow and are not planning to get pregnant, they can be followed up without immediate treatment. Growth hormone (GH) microadenomas: 1. Preferred surgical treatment. Transsphenoidal surgery is the preferred treatment for patients with GH microadenomas and has good results. 2. Medications. Growth hormone mimetic drugs, such as oxytetracycline and santoprene, etc. These drugs can reduce blood GH and IGF-1 to normal levels in 50%-60% of patients and can improve symptoms in more than 90% of patients. The drugs are more expensive. The main side effects are gastrointestinal reactions and gallbladder stones.3. Radiotherapy. Radiation therapy is an option for patients with contraindications to surgery or for patients with residual tumors after surgery. Radiotherapy is relatively effective for GH microadenoma, and 60%-90% of GH adenoma are more sensitive to radiotherapy. Most of them achieve significant results in about 2 years, but up to 40% of them have hypopituitarism after radiotherapy. It is contraindicated in patients with visual field defects and intracranial hypertension. Adrenocorticotropic hormone (ACTH) microadenomas: surgery is the preferred treatment. Selective transsphenoidal approach microadenectomy can achieve endocrinological remission in 95% of patients, while the function of the anterior pituitary gland can be normalized. Sometimes only normal or hyperplastic pituitary tissue is removed, but complete remission can be achieved in 2/3 of patients after surgery. Microadenomas with no significant functional impact: the principle of management is regular follow-up. In the absence of pressure or endocrinological manifestations, treatment, especially surgery, need not be considered at all. In conclusion, the treatment of pituitary microadenomas should be individualized. Some patients need only follow-up, some patients need transsphenoidal sinus surgery, and some patients have drug therapy as the first choice. Expert neurosurgeon network provided by http://www.scsjt.cn Consultation number 13188873256