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Pharmacy World and Science

, Volume 16, Issue 5, pp 201–207 | Cite as

Pituitary adenomas, some diagnostic and therapeutical aspects

  • A. J. van der Lely
  • W. W. de Herder
  • S. W. J. Lamberts
Pharmacotherapy Evaluations
  • 13 Downloads

Abstract

The treatment of almost all types of pituitary adenomas has changed considerably in recent years. New types of drugs as well as improved application forms of older drug therapies are now becoming more and more available for everyday treatment of patients with these relatively rare diseases. For the most frequently occurring pituitary adenomas the drugs of first choice are described, as well as other available treatments, their indications and efficacies. Also the main side-effects are described.

Keywords

Adenoma Adverse effects Diagnosis Dopaminergic agents Hormone antagonists Ketoconazole Octreotide Pituitary diseases 
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References

  1. 1.
    Burrow GN, Wortzman G, Rewcastle NB, Holgate RC, Kovacs K. Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med 1981;304:156–8.Google Scholar
  2. 2.
    McComb DJ, Ryan N, Horvath E, Kovacs K. Subclinical adenomas of the human pituitary. New light on old problems. Arch Pathol Lab Med 1983;107:488–92.Google Scholar
  3. 3.
    Kovacs K, Horvath E, Ezrin C. Anatomy and histology of the normal and abnormal pituitary gland. In: De Groot J, Cahill Jr GF, Odell WD, Martini L, Potts Jr JT, Nelson DH, et al. editors. Endocrinology. Philadelphia: W.B. Saunders Company, 1989:271–81.Google Scholar
  4. 4.
    Wilson CB, Dempsey LC. Transsphenoidal microsurgical removal of 250 pituitary adenomas. J Neurosurg 1978;48:13–22.Google Scholar
  5. 5.
    Scheithauer BW, Kovacs K, Laws ER Jr, Randall RV. Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg 1986;65:733–44.Google Scholar
  6. 6.
    Flier JS, Underhill LH. Diagnosis and management of hormone-secreting pituitary adenomas. N Engl J Med 1991;324:822–31.Google Scholar
  7. 7.
    Schlechte J, Dolan K, Sherman B, Chapler F, Luciano A. The natural history of untreated microprolactinemia: a perspective analysis. J Clin Endocrinol Metab 1989;68:412–8.Google Scholar
  8. 8.
    Klibanski A, Greenspan SL. Increase in bone mass after treatment of hyperprolactinemic amenorrhea. N Engl J Med 1986;315:542–6.Google Scholar
  9. 9.
    Serri O, Rasio E, Beauregard H, Hardy J, Somma M. Recurrence of hyperprolactinemia after selective transsphenoidal adenomectomy in women with prolactinoma. N Engl J Med 1983;309:280–3.Google Scholar
  10. 10.
    Tran LM, Blount L, Horton D, Sadechi A, Parker RG. Radiation therapy of pituitary tumors: results in 95 cases. Am J Clin Oncol 1991;14:25–9.Google Scholar
  11. 11.
    Clarke SD, Woo SY, Butler EB, Dennis WS, Lu H, Carpenter LS, et al. Treatment of secretory pituitary adenoma with radiation therapy. Radiology 1993;188:759–63.Google Scholar
  12. 12.
    Benker G, Jaspers C, Hausler G, Reinwein D. Control of prolactin secretion. Klin Wochenschr 1990;68:1157–67.Google Scholar
  13. 13.
    Thorner MO, Martin WH, Rogol AD, Morris JL, Perryman RL, Conway BP, et al. Rapid regression of pituitary prolactinomas during bromocriptine treatment. J Clin Endocrinol Metab 1980;51:438–45.Google Scholar
  14. 14.
    Molitch ME, Elton RL, Blackwell RE, Caldwell B, Chang RJ, Jaffe R, et al. Bromocriptine as primary therapy for prolactinsecreting macroadenomas: results of a prospective multicentre study. J Clin Endocrinol Metab 1985;60:698–705.Google Scholar
  15. 15.
    Thorner MO, Perryman RL, Rogol AD, Conway BP, MacLeod RM, Login IS, et al. Rapid changes of prolactinoma volume after withdrawal and reinstitution of bromocriptine. J Clin Endocrinol Metab 1981;53:480–3.Google Scholar
  16. 16.
    Vance ML, Evans WS, Thorner MO. Bromocriptine. Ann Intern Med 1984;100:78–91.Google Scholar
  17. 17.
    Crosignani PG, Ferrari C, Liuzzi A, Benco R, Mattei A, Rampini P, et al. Treatment of hyperprolactinemic states with different drugs: a study with bromocriptine, metergoline, and lisuride. Fertil Steril 1982;37:61–7.Google Scholar
  18. 18.
    Dallabonzana D, Liuzzi A, Oppizzi G, Cozzi R, Verde G, Chiodini P, et al. Chronic treatment of pathological hyperprolactinemia and acromegaly with the new ergot derivative terguride. J Clin Endocrinol Metab 1986;63:1002–7.Google Scholar
  19. 19.
    Scarduelli C, Cavioni V, Galparoli C, Spellecchia D, Ferrari C, Crosignani PG. Clinical use of a new anti-prolactinemic drug: dihydroergocristine. J Obstet Gynecol 1987;7:225–7.Google Scholar
  20. 20.
    Bouloux PMG, Besser GM, Grossman A, Moult PJA. Clinical evaluation of lisuride in the management of hyperprolactinemia. BMJ 1987;294:1323–4.Google Scholar
  21. 21.
    Grossman A, Bouloux PMG, Loneragan R, Rees RH, Wass JAH, Besser GM. Comparison of the clinical activity of mesulergine and pergolide in the treatment of hyperprolactinemia. Clin Endocrinol (Oxf) 1985;22:611–6.Google Scholar
  22. 22.
    Mattei GB, Ferrari C, Baroldi P, Cavioni V, Paracchi A, Galparoli C, et al. Prolactin-lowering effect of acute and once weekly repetitive oral administration of cabergoline at two dose levels in hyperprolactinemic patients. J Clin Endocrinol Metab 1988;66:193–8.Google Scholar
  23. 23.
    Melis GB, Gambacciani M, Paoletti AM, Beneventi F, Mais V, Baroldi P, et al. Dose-related prolactin inhibitory effects of the new long-acting dopamine agonist cabergoline in normal cycling, puerperal, and hyperprolactinemic women. J Clin Endocrinol Metab 1987;65:541–5.Google Scholar
  24. 24.
    Ferrari C, Mattei A, Melis GB, Paracchi A, Muratori M, Faglia G, et al. Cabergoline: long-acting oral treatment of hyperprolactinemic disorders. J Clin Endocrinol Metab 1989;68:1201–5.Google Scholar
  25. 25.
    Ciccarelli E, Giusti M, Miola C, Potenzoni F, Sghedoni D, Camanni F, et al. Effectiveness and tolerability of long term treatment with cabergoline, a new long-lasting ergoline derivative, in hyperprolactinemic patients. J Clin Endocrinol Metab 1989;69:725–8.Google Scholar
  26. 26.
    Kleinberg DL, Boyd III AE, Wardlaw S, Frantz AG, George A, Bryan N, et al. Pergolide for the treatment of pituitary tumors secreting prolactin or growth hormone. N Engl J Med 1983;309:704–9.Google Scholar
  27. 27.
    Kletsky OA, Borenstein R, Mileikowsky GN. Pergolide and bromocriptine for the treatment of patients with hyperprolactinemia. Am J Obstet Gynecol 1986;154:431–5.Google Scholar
  28. 28.
    Lamberts SWJ, Quik RF. A comparison of the efficacy and safety of pergolide and bromocriptine in the treatment of hyperprolactinemia. J Clin Endocrinol Metab 1991;72:635–41.Google Scholar
  29. 29.
    Venetikou MS, Burrin JM, Woods CA, Yeo TH, Brownell J, Adams EF. Effects of two novel dopaminergic drugs, CV 205–502 and ECP 201–403 on prolactin and growth hormone secretion by human pituitary tumoursin vitro. Acta Endocrinol 1987;116:287–92.Google Scholar
  30. 30.
    Vance ML, Cragun C, Reimnitz C, Chang R, Rashef E, Blackwell R, et al. CV 205–502 treatment of hyperprolactinaemia. J Clin Endocrinol Metab 1989;68:336–9.Google Scholar
  31. 31.
    Newman CB, Hurley AM, Kleinberg DL. Effect of CV 205–502 in hyperprolactinaemic patients intolerant of bromocriptine. Clin Endocrinol (oxf) 1989;31:391–400.Google Scholar
  32. 32.
    Van 't Verlaat JW, Croughs RJ, Brownell J. Treatment of macroprolactinomas with a new non-ergot, long-acting dopaminergic drug, CV 205–502. Clin Endocrinol (Oxf) 1990;33:619–24.Google Scholar
  33. 33.
    Van der Lely AJ, Brownell J, Lamberts SWJ. The efficacy and tolerability of CV 205–502 (a non-ergot dopaminergic drug) in macroprolactinoma patients and in patients intolerant to bromocriptine. J Clin Endocrinol Metab 1991;72:1136–41.Google Scholar
  34. 34.
    Kvistborg A, Halse J, Bakke S, Bjoro T, Hansen E, Djoseland O, et al. Long-term treatment of macroprolactinomas with CV 205–502. Acta Endocrinol (Copenh) 1993;128:301–7.Google Scholar
  35. 35.
    Liddle GW. Tests of pituitary-adrenal suppressibility in the diagnosis of Cushing's syndrome. J Clin Endocrinol Metab 1960;20:1539–60.Google Scholar
  36. 36.
    Laudat MH, Billaud L, Thomopoulos P, Vera O, Yllia A, Luton JP. Evening urinary free corticoids: a screening test in Cushing's syndrome and incidentally discovered adrenal tumours. Acta Endocrinol (Copenh) 1988;119:459–64.Google Scholar
  37. 37.
    Biemond P, De Jong FH, Lamberts SWJ. Continuous dexamethasone infusion for seven hours in patients with the Cushing's syndrome. A superior differential diagnostic test. Ann Intern Med 1990;112:738–42.Google Scholar
  38. 38.
    Chrousos GP, Schulte HM, Oldfield EH, Gold PW, Cutler Jr GB, Loriaux DL. The corticotrophin-releasing factor stimulation test. An aid in the evaluation of patients with Cushing's syndrome. N Engl J Med 1984;310:622–6.Google Scholar
  39. 39.
    Doppman JL, Frank JA, Dwyer AJ, Oldfield EH, Miller DL, Nieman LK, et al. Gadolinium DTPA enhanced MR imaging of corticotropin-secreting microadenomas of the pituitary gland. J Comput Assist Tomogr 1988;12:728–35.Google Scholar
  40. 40.
    Peck WW, Dillon WP, Norman D, Newton TH, Wilson CB. High-resolution MR imaging of pituitary microadenomas at 1.5 T: experience with Cushing's disease. Am J Rad 1989;52:145–51.Google Scholar
  41. 41.
    Findling JW, Kehoe ME, Shaker JL, Raff H. Routine inferior petrosal sinus sampling in the differential diagnosis of adrenocorticotropin(corticotropin)-dependent Cushing's syndrome: early recognition of the occult ectopic ACTH syndrome. J Clin Endocrinol Metab 1991;73:408–13.Google Scholar
  42. 42.
    Miller DL, Doppman JL. Petrosal sinus sampling; technique and rationale. Radiology 1991;178:37–47.Google Scholar
  43. 43.
    Tran LM, Blount L, Horton D, Sadeghi A, Parker RG. Radiation therapy of pituitary tumours: results in 95 cases. Am J Clin Oncol 1991;14:25–9.Google Scholar
  44. 44.
    Howlett TA, Drury PL, Perry L, Doniach I, Rees LH, Besser GM. Diagnosis and management of ACTH-dependent Cushing's syndrome: comparison of the features in ectopic and pituitary ACTH production. Clin Endocrinol 1986;24:699–713.Google Scholar
  45. 45.
    Jeffcoate WJ, Rees JH, Tomlin S. Metyrapone in long-term management of Cushing's disease. BMJ 1988;296:227–30.Google Scholar
  46. 46.
    Shaw MA, Nicholls PJ, Smith HJ. Aminogluthetimide and ketoconazole: historical perspectives and future prospectives. J Steroid Biochem 1988;31:137–46.Google Scholar
  47. 47.
    Bruynseels J, De Coster R, Van Rooy P, Wouters W, Coene MC, Snoeck E, et al. R 75251, a new inhibitor of steroid biosynthesis. Prostate 1990;16:345–57.Google Scholar
  48. 48.
    Lamberts SW, Bons EG, Bruining HA, De Jong FH. Differential effects of the imidazole derivatives etomidate, ketoconazole and miconazole and of metyrapone on the secretion of cortisol and its precursors by human adrenocortical cells. J Pharmacol Exp Ther 1987;240:259–64.Google Scholar
  49. 49.
    Tabarin A, Navarranne A, Guerin J, Corcuff JB, Parneix M, Roger P. Use of ketoconazol in the treatment of Cushing's disease and ectopic ACTH syndrome. Clin Endocrinol (Oxf) 1991;34:63–9.Google Scholar
  50. 50.
    Khanderia U. Use of ketoconazol in the treatment of Cushing's syndrome. Clin Pharm 1991;10:12–3.Google Scholar
  51. 51.
    Hoffman DM, Brigham B. The use of ketoconazole in ectopic adrenocorticotropic hormone syndrome. Cancer 1991;1:1447–9.Google Scholar
  52. 52.
    Mortimer RH, Cannell GR, Thew CM, Galligan JP. Ketoconazole and plasma and urine steroid levels in Cushing's disease. Clin Exp Pharmacol Physiol 1991;18(8):563–9.Google Scholar
  53. 53.
    Lamberts SWJ, Bons EG, Uitterlinden P. Studies on the glucocorticoid receptor blocking action of RU 38486 in cultured ACTH-secreting human pituitary tumor cells and normal rat pituitary cells. Acta Endocrinol (Copenh) 1985;109:64–9.Google Scholar
  54. 54.
    Gaillard RD, Poffet D, Diondel AM, Saurat JH. RU 486 inhibits peripheral effects of glucocorticoids in humans. J Clin Endocrinol Metab 1985;61:1009–14.Google Scholar
  55. 55.
    Van der Lely AJ, Foeken K, Van der Mast RC, Lamberts SWJ. Rapid reversal of acute psychosis in patients with severe Cushing's syndrome. Ann Intern Med 1991;114:143–4.Google Scholar
  56. 56.
    Raux-Demay MC, Pierret T, Bouvier d'Yvoire M, Bertagna X, Girard F. Transient inhibition of RU 486 antiglucocorticoid action by dexamethasone. J Clin Endocrinol Metab 1990;70:230–3.Google Scholar
  57. 57.
    Klibanski A. Nonsecreting pituitary tumors. Endocrinol Metab Clin North Am 1987;16:793–804.Google Scholar
  58. 58.
    Kwekkeboom DJ. Clinically nonfunctioning and gonadotroph pituitary adenomas [dissertation]. Rotterdam:Erasmus University, 1989.Google Scholar
  59. 59.
    Ebersold MJ, Quast LM, Laws ER, Scheithauer B, Randall RV. Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 1986;64:713–9.Google Scholar
  60. 60.
    Comtois R, Beauregard H, Somma M, Serri O, Aris-Jilwan N, Hardy J. The clinical and endocrine outcome to transsphenoidal microsurgery of nonsecreting pituitary adenomas. Cancer 1991;68:860–6.Google Scholar
  61. 61.
    Oppenheim DS, Klibanski A. Medical therapy of glycoprotein hormone-secreting pituitary tumors. Endocrinol Metab Clin North Am 1989;18:339–58.Google Scholar
  62. 62.
    Warnet A, Timsit J, Chanson P, et al. The effect of somatostatin analogue on chiasmal dysfunction from pituitary macroadenomas. J Neurosurg 1989;71:687–90.Google Scholar
  63. 63.
    Kwekkeboom DJ, Lamberts SWJ, Blom JHN, Schroeder FH, De Jong FH. Prolonged treatment with the GnRH analog busurelin suppresses LH-β production by the pituitary gonadotroph, while alpha-subunit production does not change. Clin Endocrinol (Oxf) 1990;32:443–51.Google Scholar
  64. 64.
    Kwekkeboom DJ, Lamberts SWJ. Long-term treatment with the dopamine agonist CV 205-502 of patients with a clinically nonfuctioning, gonadotroph, or alpha-subunit secreting pituitary adenoma. Clin Endocrinol (Oxf) 1992;36:171–6.Google Scholar
  65. 65.
    Fagin JA, Brown A, Melmed S. Regulation of pituitary insulinlike growth factor-I messenger ribonucleic acid levels in rats harbouring somatomammotrophic tumors: implications for growth hormone autoregulation. Endocrinol 1988;122:2204–10.Google Scholar
  66. 66.
    Yamashita S, Melmed S. Insulin-like growth factor-I regulation of growth hormone gene transcription in primary rat pituitary cells. J Clin Invest 1987;79:449–52.Google Scholar
  67. 67.
    Mathews LS, Hammer RE, Behringer RR, D'Ercole AJ, Bell GI, Brinster RL, et al. Growth enhancement of transgenic mice expressing human insulin-like growth factor I. Endocrinology 1988;123:2827–33.Google Scholar
  68. 68.
    Klijn JGM, Lamberts SWJ, De Jong FH, Van Dongen KJ, Birkenhager JC. Interrelationships between tumour size, age, plasma growth hormone and incidence of extra sellar extension in acromegalic patients. Acta Endocrinol (Copenh) 1980;95:289–97.Google Scholar
  69. 69.
    Smals AEM, Pieters GFFM, Smals AGH, Kloppenborg PWC. Sex difference in the relation between sellar volume and basal and GH-releasing hormone stimulated GH in acromegaly. Acta Endocrinol (Copenh) 1986;88:224–36.Google Scholar
  70. 70.
    Lamberts SWJ, Uitterlinden P, Verleun T. Relationship between growth hormone and somatomedin-C levels in untreated acromegaly, after surgery and radiotherapy and during medical treatment with sandostatin (SMS 201-995). Eur J Clin Invest 1987;17:354–9.Google Scholar
  71. 71.
    Barkan AL, Beitins IZ, Kelch RP. Plasma insulin-like growth factor-I/somatomedin-C in acromegaly: correlation with the degree of growth hormone hypersecretion. J Clin Endocrinol Metab 1988;67:69–73.Google Scholar
  72. 72.
    Van der Lely AJ, Harris AG, Lamberts SWJ. The sensitivity of growth hormone secretion to medical treatment in acromegalic patients: influence of age and sex. Clin Endocrinol (Oxf) 1992;37:181–5.Google Scholar
  73. 73.
    Wright AD, Hill DM, Lowy C, Fraser TR. Mortality in acromegaly. Q J Med 1970;39:1–16.Google Scholar
  74. 74.
    Barkan AL. Acromegaly diagnosis and therapy. Endocrinol Metab Clin 1989;18:277–310.Google Scholar
  75. 75.
    Kliman B, Kjellberg RN, Swisher B, Butler W. Long-term effects of proton-beam therapy for acromegaly. In: Robbins RJ, Melmed S, editors. Acromegaly: a century of scientific and clinical progress. New York: Plenum Press, 1987:221–8.Google Scholar
  76. 76.
    Snyder PJ, Fowble BF, Schatz NJ, Savino PJ, Gennarelli TA. Hypopituitarism following radiation therapy of pituitary adenomas. Am J Med 1986;81:457–62.Google Scholar
  77. 77.
    Lamberts SWJ, Liuzzi A, Chiondini PG, Verde S, Klijn JG, Birkenhager JC. The value of plasma prolactin levels in the prediction of the responsiveness of growth hormone secretion to bromocriptine and TRH in acromegaly. Eur J Clin Invest 1982;12:151–5.Google Scholar
  78. 78.
    Wass JA, Thorner MO, Morris DV, Rees LH, Mason AS, Jones AE, et al. Long-term treatment of acromegaly with bromocriptine. BMJ 1977;1:875–78.Google Scholar
  79. 79.
    Halse J, Harris AG, Kvistborg A, Kjartansson O, Hanssen E, Smiseth O, et al. Randomized study of SMS 201-995 versus bromocriptine treatment in acromegaly: clinical and biochemical effects. J Clin Endocrinol Metab 1990;70:1254–61.Google Scholar
  80. 80.
    Chiodine PG, Attanasio R, Cozzi R, Dallabonzana D, Oppizzi G, Strada S, et al. CV 205-502 in acromegaly. Acta Endocrinol (Copenh) 1993;128:389–93.Google Scholar
  81. 81.
    Lamberts SWJ. The role of somatostatin in the regulation of anterior pituitary hormone secretion and the use of its analogs in the treatment of human pituitary tumors. Endocr Rev 1988;9:417–36.Google Scholar
  82. 82.
    Plewe G, Beyer J, Krause U, Neufeld M, Del Pozo E. Longacting and selective suppression of growth hormone secretion by somatostatin analogue SMS 201-995 in acromegaly. Lancet 1984;2:782–4.Google Scholar
  83. 83.
    Barkan AL, Lloyd RV, Chandler WF, Hatfield MK, Gebarski SS, Kelch RP, et al. Preoperative treatment of acromegaly with long-acting somatostatin analog SMS 201-995: shrinkage of invasive pituitary macroadenomas and improved surgical remission rate. J Clin Endocrinol Metab 1988;67:1040–8.Google Scholar
  84. 84.
    Ezzat S, Snyder PJ, Young WF, Boyajy LD, Newman C, Klibanski A, et al. Octreotide treatment of acromegaly. A randomized, multicentre study. Ann Intern Med 1992;117:711–8.Google Scholar
  85. 85.
    Van Liessum PA, Hopman WPM, Pieters GFFM, Jansen JB, Smals AG, Rosenbusch G, et al. Postprandial gallbladder motility during long term treatment with the long-acting somatostatin analog SMS 201-995 in acromegaly. J Clin Endocrinol Metab 1989;69:557–62.Google Scholar
  86. 86.
    Heron I, Thomas F, Dero M, Gancel A, Ruiz JM, Schatz B, et al. Pharmacokinetics and efficacy of a long-acting formulation of the new somatostatin analog BIM 23014 in patients with acromegaly. J Clin Endocrinol Metab 1993;76:721–7.Google Scholar

Copyright information

© Royal Dutch Association for Advancement of Pharmacy 1994

Authors and Affiliations

  • A. J. van der Lely
    • 1
  • W. W. de Herder
    • 1
  • S. W. J. Lamberts
    • 1
  1. 1.Department of Medicine, University Hospital DijkzigtErasmus University RotterdamGD RotterdamThe Netherlands

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