The pharmacological treatment of hormone-secreting pituitary tumors has come a long way in recent years with the continuous improvement of drug development.
For pituitary prolactin-secreting tumors, the current view is that more than 90% of patients (both microadenomas and macroadenomas) can have their PRL levels controlled with dopamine agonists (short-acting agents bromocriptine, long-acting agents cabergoline) to reduce the size of the tumor. Surgery is an option only for patients with prolactinomas who are allergic or drug intolerant to this class of drugs, who have acute symptoms due to tumor compression requiring emergency surgical decompression, or for patients who do not wish to undergo surgical treatment. During treatment with bromocriptine, the dose of bromocriptine should be gradually increased until the serum PRL level drops to normal level and then the dose is adjusted for long-term maintenance treatment. For patients with fertility requirements, bromocriptine should be discontinued after pregnancy. The vision should be reviewed regularly during pregnancy until bromocriptine treatment is resumed after delivery. For patients who experience miscarriage or stillbirth when bromocriptine is discontinued after pregnancy, the drug should be maintained until the dose of bromocriptine is adjusted after delivery. It has been clinically proven that no significant malformations or mental retardation have been observed in children born to pregnant women while taking bromocriptine.
For growth hormone-secreting pituitary tumors, the major advance in the last 20 years has been the use of growth inhibitory analogs. The clinical application of this drug has led to a significant increase in the cure rate of GH-secreting tumors. The use of long-acting preparations of growth inhibitor analogs such as long-acting octreotide and somatuline in recent years has led to a significant increase in patient compliance. Preoperative application of these drugs can rapidly reduce the patient’s serum GH level, alleviate the patient’s symptoms, reduce the size of the tumor, and create good preoperative conditions for the complete removal of the tumor. Additional indications for the use of growth hormone analogs in GH-secreting tumors include: postoperative residual patients, and transitional treatment of patients whose GH has not been reduced to normal after radiotherapy. The application of growth hormone analogs provides the opportunity to prepare treatment before surgery for those patients who are unable to tolerate anesthesia due to concomitant heart failure, respiratory sleep apnea, poorly controlled hyperglycemia, and hypertension. In foreign countries, many patients who do not want to undergo surgical treatment have also achieved satisfactory therapeutic results with long-term application of growth inhibitor therapy for tumor control because they do not have to worry about medical costs. Growth inhibitor analogs for thyrotropin-secreting tumors have also achieved satisfactory therapeutic results. After application of drug therapy for GH-secreting pituitary tumors, it is now accepted that reduction of GH levels to less than 1ng/dl (GH value after glucose administration) and insulin-like growth factor (IGF-1) to the level of age-matched normal individuals in patients with GH-secreting tumors is the goal of biochemical cure. Patients with growth hormone-secreting tumors, regardless of the treatment they receive, should achieve several therapeutic goals: elimination of the tumor, reduction of tumor recurrence, GH attainment, relief of clinical symptoms, preservation of pituitary function as much as possible, improvement of the patient’s quality of life, and extension of the patient’s survival.