Treatment depends upon the type of pituitary tumour present:

  • Prolactin-producing tumours (50%) are treated with dopamine agonists; surgery is reserved for cases that are poorly responsive and radiotherapy is only used when both approaches have failed or are not possible
  • Growth hormone producing tumours (30%) are treated with surgery in most cases; where surgery is unsuccessful or not possible medical therapy with somatostatin analogues is used. Radiotherapy may be used after surgical and medical therapy has been unsuccessful
  • Microadenomas (< 10 mm) are usually hormone producing (eg. TSH, ACTH); surgery is recommended for all cases with radiotherapy (45 Gy) used for inoperable cases or when surgery is unsuccessful
  • Macroadenomas (> 10 mm) are also usually treated with surgery with radiotherapy reserved for inoperable cases

In general, radiotherapy works too slowly for the majority of tumours to provide immediate relief from hormonal changes. Therefore surgery is preferred. The typical radiotherapy dose is 45 Gy in 25 fractions (below tolerances of chiasm).
Medical management of underlying hormonal imbalances is also helpful (eg. adrenal hormone suppressors).