A patient is diagnosed with pituitary tumour, prolactinoma encircling the carotid artery. What is the best line of management?
B i.e. Transsphenoidal surgical resectionBailey and Love, 27th edition, page 665-666Explanation:Most of the tumors in sellar region are benign pituitary adenomas, but also include craniopharyngiomas, meningiomas, aneurysm and rathke cleft cyst.Pituitary microadenomas are less than 1 cm in size and macroadenomas are more than 1 cm.Microadenomas present with endocrine effects, whereas macroadenomas present with visual field defects.Majority of the adenomas are prolactinomas (30%), 20% are non-functioning, 15% secrete GH and 10% secrete ACTH.Baseline assessment of serum prolactin, FSH and LH, TFT and Fasting serum GH and cortisol is necessary.Prolactinomas are initially managed with dopamine agonists like bromocriptine and cabergoline.Compression of the chiasm with evidence of visual compromise, encasement of nearby cavernous sinus or carotid arteries are the indications of surgical intervention.Surgical resection is usually performed through transsphenoidal approach using a microscope or endoscope inserted through nose.Postoperative complications include CSF leak, pituitary insufficiency and SIADH.
Wait and watch
Transsphenoidal surgical resection
Radiotherapy
Combination
Nervous System