text: Somatotrophic adenomas are primarily treated with transsphenoidal pituitary surgery, especially if symptoms of acromegaly are present. A second line treatment strategy (which can be used if there is a persistent or recurrent mass or symptoms after surgery) utilizes medical therapy, including octreotide or lanreotide, which are long-acting somatostatin analogs. These somatostatin receptor analogs inhibit secretion of growth hormone. They were found to be about 50–55% effective in reducing tumor mass and reducing growth hormone and insulin like growth factor 1 (IGF-1) levels in studies. The growth hormone receptor antagonist pegvisomant is also used in the treatment of somatotrophic adenomas. Pegvisomant blocks the action of growth hormone. It can either be used as monotherapy or combined with a somatostatin analog.
  Corticotropinomas are primarily treated with transsphenoidal pituitary surgery, especially if signs and symptoms of Cushing syndrome are present. Medication therapy is second line, and includes steroidogenesis inhibitors (ketoconazole, metyrapone, osilodrostat, etomidate or mitotane) which decrease production of cortisol, pituitary blockers such as somatostatin receptor ligand pasireotide or the dopamine agonist cabergoline, or the glucocorticoid receptor antagonist mifepristone. These medications can be combined for a synergistic effect. Medication therapy is often used in conjunction with radiation therapy for corticotropinomas.
  Surgery is a common treatment for pituitary tumors. The normal approach is trans-sphenoidal adenectomy, which usually can remove the tumor without affecting the brain or optic nerves.
  Radiation is also used to treat pituitary adenomas. Examples include external beam or proton beam radiation therapy or stereotactic radiosurgery. External radiation of pituitary adenomas can arrest tumor growth for several years but pituitary failure develops within 10 years in most patients necessitating lifelong hormone replacement. Radiation therapy for pituitary adenomas is associated with a four-fold increase in mortality due to cerebrovascular disease. Lifelong monitoring of pituitary hormones is recommended after radiation therapy as hypopituitarism developed in 17% of those undergoing radiation therapy.