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9 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Pituitary tumours are usually benign growths of the hormone gland at the base of the brain that cause trouble by overproducing hormones or pressing on the optic nerves. Prolactin-producing tumours melt away with a tablet, most others are cured by surgery through the nose, and the rare aggressive ones respond to the chemotherapy drug temozolomide.
Pituitary neuroendocrine tumours (PitNETs, the WHO 2022 term for pituitary adenomas) are classified by cell lineage using transcription factors (PIT1, TPIT, SF1) and hormone expression: lactotroph (prolactinoma), somatotroph (acromegaly), corticotroph (Cushing disease), gonadotroph (usually non-functioning) and rarer types. Most are sporadic; germline AIP, MEN1, CDKN1B and other mutations account for young-onset and familial cases. Aggressive PitNETs invade the cavernous sinus and recur despite surgery and radiotherapy; pituitary carcinoma is defined by cerebrospinal or systemic metastasis and is very rare. Because the NCI lists pituitary tumours among cancer types and their management sits between endocrinology, neurosurgery and oncology, they belong in a complete corpus.
Treatment is lineage-specific. Prolactinomas respond to dopamine agonists (cabergoline) in most cases, with surgery reserved for resistance or intolerance. Other functioning and symptomatic non-functioning tumours are treated by transsphenoidal endoscopic surgery; acromegaly not cured by surgery is controlled with first-generation somatostatin analogues (octreotide, lanreotide), pasireotide or pegvisomant; Cushing disease with surgery, then steroidogenesis inhibitors (osilodrostat, metyrapone) or pasireotide. Radiotherapy, increasingly stereotactic radiosurgery, controls residual or recurrent tumour. For aggressive tumours and carcinomas the European Society of Endocrinology guideline (2018) recommends temozolomide as first-line chemotherapy, with response predicted in part by low MGMT expression; checkpoint inhibitors have produced responses in corticotroph carcinomas in case series.
| Setting | Approach | Guideline |
|---|---|---|
| Prolactinoma | Cabergoline first line, titrated to normal prolactin and tumour shrinkage; surgery for resistance, intolerance or pituitary apoplexy. | not mapped |
| Acromegaly, Cushing disease, symptomatic non-functioning tumours | Endoscopic transsphenoidal resection; medical therapy for persistent disease (somatostatin analogues, pasireotide, pegvisomant for acromegaly; osilodrostat, metyrapone for Cushing); radiotherapy or radiosurgery for residual tumour. | not mapped |
| Aggressive PitNET or pituitary carcinoma | Temozolomide (standard schedule, at least 3 cycles before assessing response), with radiotherapy where not previously given; PRRT for SSTR-positive tumours, bevacizumab or checkpoint inhibitors in trials or case series after temozolomide failure. | not mapped |