At present, with the increasing understanding of pituitary adenoma, the management concept of pituitary adenoma has also undergone a major change, which is manifested in the following aspects.
①Change of treatment concept
In the past, we have changed from pursuing total removal of the tumor without regard to the surgical effect to putting the patient’s survival quality in the first place and removing the tumor in the second place.
②Advocate early diagnosis and treatment of pituitary adenoma
We continuously promote the scientific knowledge of pituitary adenoma, so that the medical staff of related departments including ophthalmology, endocrinology, neurology, mammary gland department and male department have enough knowledge of this disease, and also make the general public have some understanding of this disease. MRI scan can detect pituitary microadenoma of about 1mm, PET and PET-CT can metabolically diagnose pituitary microadenoma early, improve the positive detection rate, and provide help for some complex pituitary adenoma.
③The diagnosis and treatment of pituitary adenoma should be standardized
Patients with pituitary adenoma have different clinical manifestations due to different types of disease, degree of morbidity, and individual differences, and the comprehensive level of the hospitals they visit varies, so the treatment measures taken and the therapeutic effects are also obviously different. In order to ensure the needs of clinical work, the Neurosurgery Branch of the Chinese Medical Association and the Chinese Endocrine Branch jointly formulated the Guidelines for the Treatment of Acromegaly in 2006, and together with the Endocrine Society and Obstetrics and Gynecology Branch jointly formulated the Guidelines for the Treatment of Pituitary Prolactin Adenoma.
This is a standard developed to comprehensively improve and standardize the diagnosis and treatment of pituitary adenoma, and provide a uniform clinical diagnosis and treatment pathway nationwide. It is the requirement of the times and the urgent need of neurologists to be able to formulate the Guidelines for the Treatment of Pituitary Adenoma as soon as possible.
④ Emphasis on individualized treatment and comprehensive treatment
According to the specific conditions of different patients, we should take into account their conditions and imaging diagnosis as well as the requirements of their families, and give comprehensive consideration to individualization, including control of hormone levels, selection of surgical access, preoperative preparation, tumor removal, prevention of complications and postoperative follow-up. At the same time, comprehensive treatment should be given to pituitary adenoma, including surgery, drugs and radiotherapy.
Multi-disciplinary cooperation, including endocrinology, ophthalmology, neurosurgery, cardiology, obstetrics and gynecology, should be promoted to maximize the treatment effect. In the process of diagnosis and treatment, we should prevent “excessive treatment” and “harmful treatment”, and follow the principles of comprehensive assessment, scientific decision-making, standardization and individualization.
⑤ First choose surgical treatment
The purpose of surgery is to
(1) To relieve the pressure of the tumor on the visual pathway and surrounding structures;
(2) To restore or reduce endocrine hormone abnormalities and preserve normal pituitary and target gland functions;
(3) To remove tumor tissue and obtain tumor specimens;
(4) Reduce the chance of tumor recurrence;
(5) To create conditions for other treatments.
Among them, transsphenoidal surgery is applicable to most pituitary adenomas, which is safe, simple, quick and economical compared with traditional surgery, and can achieve satisfactory or more satisfactory results.
(6) Pay extra attention to invasive pituitary adenoma and adopt multi-method treatment
Because the diagnosis standard of invasive pituitary adenoma is not uniform, single surgery resection is difficult, treatment effect is poor, also easy to recur, and prognosis is often poor, so clinicians need to combine imaging, surgical resection, pathological confirmation and postoperative radiotherapy in order to improve the surgical efficacy.
Further exploration and research are needed in terms of anatomy of the pterygoid saddle area, imaging, surgical access selection, surgical instrumentation and equipment, surgical techniques, adjuvant radiotherapy and drug therapy, as well as etiological mechanisms and molecular biological properties.
(7) To choose radiotherapy correctly
Since radiotherapy can cause hypopituitarism and irreversible damage to the optic nerve and inferior optic thalamus, the radiotherapy treatment plan should be formulated by the specialist radiotherapist according to the condition, tumor size, distance between tumor and optic nerve, degree of surgical resection, endocrine examination, and family’s wishes.