AACE MENA 2025-Pituitary Tumors, Biology and Clinical Classification

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Video Summary

Professor John Weiss delivered a comprehensive lecture on pituitary tumors, focusing on epidemiology, classification, treatment, and follow-up of various adenoma types. He emphasized that pituitary tumors are more common than often realized, with microadenomas found in about 10% of people. Key types include non-functioning adenomas, prolactinomas, acromegaly-related tumors, and Cushing's disease adenomas.<br /><br />For non-functioning adenomas, post-operative follow-up involves early MRI scans (6-12 weeks), hormonal assessments, and monitoring for complications like diabetes insipidus. Long-term surveillance is critical, especially if residual tumor remains, with scans yearly for six years, then biennially. Medical treatment with low-dose cabergoline shows promise in reducing recurrence but requires more research.<br /><br />Prolactinomas are primarily managed medically with dopamine agonists like cabergoline; surgery is reserved for resistant or intolerant cases. Stopping medication can be considered after years of control, particularly post-menopause, but many patients relapse. Estrogen therapy is not contraindicated.<br /><br />Acromegaly treatment involves surgery, medical therapies (cabergoline, somatostatin analogs, pegvisomant), and sometimes radiotherapy. Postoperative assessment includes IGF-1 measurement after three months. Colonoscopy screening after age 40 is recommended due to polyp risk.<br /><br />Cushing's disease requires early cortisol monitoring post-surgery to confirm remission, with attention to high thrombotic risk and potential anticoagulation. Recurrence rates are higher than in other pituitary tumors, necessitating vigilant long-term follow-up. Genetic factors impact recurrence risk in some cases.<br /><br />Throughout, Weiss stressed the importance of experienced multidisciplinary teams, individualized treatment decisions, and ongoing research to optimize outcomes.

Keywords

pituitary tumors

microadenomas

non-functioning adenomas

prolactinomas

acromegaly

Cushing's disease

cabergoline treatment

postoperative follow-up