A patient is diagnosed with pituitary tumour, prolactinoma encircling the carotid aery. What is the best line of management?
Treatment O Dopamine agonist, bromocriptine, can shrink prolactinomas in 75% of patients with macroadenomas in 6-8 weeks, but only as long as therapy is maintained. O Bromocriptine may also work on GH-secreting tumors with shrinkage in < 20% O Octreotide can reduce GH levels in 71% of patients with a significant reduction in tumor volume in 30% of cases Indication of surgery as an Initial treatment GH-secreting tumors Primary cushing's disease Any adenoma causing acute visual deterioration Non prolactin-secreting macroadenomas causing symptoms by mass effect Surgical approach of choice: Sublabial or intransal trans-sphenoidal approach.
Wait and watch
Transsphenoidal surgical resection
Radiotherapy
Combination
JIPMER 2017