nach oben

Pituitary

Erschienen in:

17.01.2018

Management of NFAs: medical treatment

verfasst von: Naomi Even-Zohar, Yona Greenman

Erschienen in: Pituitary | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Non-functioning pituitary adenomas (NFPAs) are in general large tumors that present with symptoms secondary to local pressure on adjacent structures. Transsphenoidal surgery is the first line of treatment but residual tumor mass is often detected post-operatively. Medical therapy, in any stage of tumor management, is not well established.

Methods

A literature search was performed to review the available data on medical treatment of NFPAs.

Results

Medications investigated for the treatment of NFPAs include dopamine receptor agonists (DA) and somatostatin receptor ligands. Randomized controlled trials are lacking, but available data suggest that DA have a positive effect on tumor remnant stabilization after surgery and could be considered in this setting. Temozolomide is reserved for aggressive tumors, although future studies are required.

Conclusions

NFPA are often not amenable to complete surgical resection. Conservative follow-up after surgery is associated with a high prevalence of tumor remnant progression. DA therapy may prevent residual tumor enlargement in over 85% of these patients, with a substantial consequent reduction in the need for repeat surgery or radiation therapy. It is our view that DA treatment should be routinely considered for the management of NFPA patients with incompletely resected tumors.

Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, McCutcheon IE (2004) The prevalence of pituitary adenomas: a systematic review. Cancer 101(3):613–619. https://doi.org/10.1002/cncr.20412 CrossRefPubMed

Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A (2006) High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab 91(12):4769–4775. https://doi.org/10.1210/jc.2006-1668 CrossRefPubMed

Fernandez A, Karavitaki N, Wass JA (2010) Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol 72(3):377–382. https://doi.org/10.1111/j.1365-2265.2009.03667.x CrossRef

Fontana E, Gaillard R (2009) Epidemiology of pituitary adenoma: results of the first Swiss study. Rev Med Suisse 5(223):2172–2174PubMed

Raappana A, Koivukangas J, Ebeling T, Pirila T (2010) Incidence of pituitary adenomas in Northern Finland in 1992–2007. J Clin Endocrinol Metab 95(9):4268–4275. https://doi.org/10.1210/jc.2010-0537 CrossRefPubMed

Molitch ME (2014) Nonfunctioning pituitary tumors. Handb Clin Neurol 124:167–184. https://doi.org/10.1016/B978-0-444-59602-4.00012-5 CrossRefPubMed

Chen Y, Wang CD, Su ZP, Chen YX, Cai L, Zhuge QC, Wu ZB (2012) Natural history of postoperative nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Neuroendocrinology 96(4):333–342. https://doi.org/10.1159/000339823 CrossRefPubMed

Greenman Y, Stern N (2009) Non-functioning pituitary adenomas. Best practice & research. Clin Endocrinol Metab 23(5):625–638. https://doi.org/10.1016/j.beem.2009.05.005

Iglesias P, Arcano K, Trivino V, Garcia-Sancho P, Diez JJ, Villabona C, Cordido F (2017) Prevalence, clinical features, and natural history of incidental clinically non-functioning pituitary adenomas. Horm Metab Res. https://doi.org/10.1055/s-0043-115645 PubMed

10.

Saeger W, Ludecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S (2007) Pathohistological classification of pituitary tumors: 10 years of experience with the German pituitary tumor registry. Eur J Endocrinol 156(2):203–216. https://doi.org/10.1530/eje.1.02326 CrossRefPubMed

11.

Lopes MBS (2017) The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol. https://doi.org/10.1007/s00401-017-1769-8

12.

Sanchez-Tejada L, Sanchez-Ortiga R, Lamas C, Camara R, Riesgo P, Fajardo C, Aranda FI, Pico A (2017) Contribution of molecular analysis to the typification of the non-functioning pituitary adenomas. PLoS ONE 12(7):e0180039. https://doi.org/10.1371/journal.pone.0180039 CrossRefPubMedPubMedCentral

13.

Mete O, Lopes MB (2017) Overview of the 2017 WHO classification of pituitary tumors. Endocr Pathol. https://doi.org/10.1007/s12022-017-9498-z

14.

Asa SL (2008) Practical pituitary pathology: what does the pathologist need to know? Arch Pathol Lab Med 132(8):1231–1240. https://doi.org/10.1043/1543-2165(2008)132[1231:PPPWDT]2.0.CO;2PubMed

15.

Larysz D, Blamek S, Rudnik A (2012) Clinical aspects of molecular biology of pituitary adenomas. Folia Neuropathol 50(2):110–117PubMed

16.

Greenman Y, Stern N (2015) Optimal management of non-functioning pituitary adenomas. Endocrine 50(1):51–55. https://doi.org/10.1007/s12020-015-0685-8 CrossRefPubMed

17.

Dekkers OM, Pereira AM, Roelfsema F, Voormolen JH, Neelis KJ, Schroijen MA, Smit JW, Romijn JA (2006) Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab 91(5):1796–1801. https://doi.org/10.1210/jc.2005-2552 CrossRefPubMed

18.

Losa M, Mortini P, Barzaghi R, Ribotto P, Terreni MR, Marzoli SB, Pieralli S, Giovanelli M (2008) Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence. J Neurosurg 108(3):525–532. https://doi.org/10.3171/JNS/2008/108/3/0525 CrossRefPubMed

19.

Woollons AC, Hunn MK, Rajapakse YR, Toomath R, Hamilton DA, Conaglen JV, Balakrishnan V (2000) Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol 53(6):713–717CrossRef

20.

Chanson P, Raverot G, Castinetti F, Cortet-Rudelli C, Galland F, Salenave S, French Endocrinology Society Non-functioning Pituitary Adenoma Work Group (2015) Management of clinically non-functioning pituitary adenoma. Ann Endocrinol 76(3): 239–247. https://doi.org/10.1016/j.ando.2015.04.002 CrossRef

21.

Kuo JS, Barkhoudarian G, Farrell CJ, Bodach ME, Tumialan LM, Oyesiku NM, Litvack Z, Zada G, Patil CG, Aghi MK (2016) Congress of neurological surgeons systematic review and evidence-based guideline on surgical techniques and technologies for the management of patients with nonfunctioning pituitary adenomas. Neurosurgery 79(4):E536–E538. https://doi.org/10.1227/NEU.0000000000001390 CrossRefPubMed

22.

Lucas JW, Bodach ME, Tumialan LM, Oyesiku NM, Patil CG, Litvack Z, Aghi MK, Zada G (2016) Congress of neurological surgeons systematic review and evidence-based guideline on primary management of patients with nonfunctioning pituitary adenomas. Neurosurgery 79(4):E533–E535. https://doi.org/10.1227/NEU.0000000000001389 CrossRefPubMed

23.

Freda PU, Beckers AM, Katznelson L, Molitch ME, Montori VM, Post KD, Vance ML, Endocrine S (2011) Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(4):894–904. https://doi.org/10.1210/jc.2010-1048 CrossRefPubMedPubMedCentral

24.

Asemota AO, Ishii M, Brem H, Gallia GL (2017) Comparison of complications, trends, and costs in endoscopic vs microscopic pituitary surgery: analysis from a US health claims database. Neurosurgery 81(3):458–472. https://doi.org/10.1093/neuros/nyx350 CrossRefPubMed

25.

Iglesias P, Arcano K, Trivino V, Garcia-Sancho P, Diez JJ, Cordido F, Villabona C (2017) Non-functioning pituitary adenoma underwent surgery: a multicenter retrospective study over the last four decades (1977–2015). Eur J Intern Med 41:62–67. https://doi.org/10.1016/j.ejim.2017.03.023 CrossRefPubMed

26.

Chittiboina P (2017) iMRI during transsphenoidal surgery. Neurosurg Clin N Am 28(4):499–512. https://doi.org/10.1016/j.nec.2017.05.005 CrossRefPubMed

27.

Dekkers OM, Hammer S, de Keizer RJ, Roelfsema F, Schutte PJ, Smit JW, Romijn JA, Pereira AM (2007) The natural course of non-functioning pituitary macroadenomas. Eur J Endocrinol 156(2):217–224. https://doi.org/10.1530/eje.1.02334 CrossRefPubMed

28.

Chang EF, Zada G, Kim S, Lamborn KR, Quinones-Hinojosa A, Tyrrell JB, Wilson CB, Kunwar S (2008) Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas. J Neurosurg 108(4):736–745. https://doi.org/10.3171/JNS/2008/108/4/0736 CrossRefPubMed

29.

Minniti G, Clarke E, Scaringi C, Enrici RM (2016) Stereotactic radiotherapy and radiosurgery for non-functioning and secreting pituitary adenomas. Rep Pract Oncol Radiother 21(4):370–378. https://doi.org/10.1016/j.rpor.2014.09.004 CrossRefPubMed

30.

Yamanaka R, Abe E, Sato T, Hayano A, Takashima Y (2017) Secondary intracranial tumors following radiotherapy for pituitary adenomas: a systematic review. Cancers. https://doi.org/10.3390/cancers9080103 PubMedPubMedCentral

31.

Brochier S, Galland F, Kujas M, Parker F, Gaillard S, Raftopoulos C, Young J, Alexopoulou O, Maiter D, Chanson P (2010) Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients. Eur J Endocrinol 163(2):193–200. https://doi.org/10.1530/EJE-10-0255 CrossRefPubMed

32.

O’Sullivan EP, Woods C, Glynn N, Behan LA, Crowley R, O’Kelly P, Smith D, Thompson CJ, Agha A (2009) The natural history of surgically treated but radiotherapy-naive nonfunctioning pituitary adenomas. Clin Endocrinol 71(5):709–714. https://doi.org/10.1111/j.1365-2265.2009.03583.x CrossRef

33.

Gatto F, Hofland LJ (2011) The role of somatostatin and dopamine D2 receptors in endocrine tumors. Endocr Relat Cancer 18(6):R233–R251. https://doi.org/10.1530/ERC-10-0334 CrossRefPubMed

34.

Neto LV, Machado Ede O, Luque RM, Taboada GF, Marcondes JB, Chimelli LM, Quintella LP, Niemeyer P Jr, de Carvalho DP, Kineman RD, Gadelha MR (2009) Expression analysis of dopamine receptor subtypes in normal human pituitaries, nonfunctioning pituitary adenomas and somatotropinomas, and the association between dopamine and somatostatin receptors with clinical response to octreotide-LAR in acromegaly. J Clin Endocrinol Metab 94(6):1931–1937. https://doi.org/10.1210/jc.2008-1826 CrossRefPubMedPubMedCentral

35.

Stefaneanu L, Kovacs K, Horvath E, Buchfelder M, Fahlbusch R, Lancranjan L (2001) Dopamine D2 receptor gene expression in human adenohypophysial adenomas. Endocrine 14(3):329–336CrossRefPubMed

36.

Renner U, Arzberger T, Pagotto U, Leimgruber S, Uhl E, Muller A, Lange M, Weindl A, Stalla GK (1998) Heterogeneous dopamine D2 receptor subtype messenger ribonucleic acid expression in clinically nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 83(4):1368–1375. https://doi.org/10.1210/jcem.83.4.4685 PubMed

37.

Verde G, Oppizzi G, Chiodini PG, Dallabonzana D, Luccarelli G, Liuzzi A (1985) Effect of chronic bromocriptine administration on tumor size in patients with “nonsecreting” pituitary adenomas. J Endocrinol Investig 8(2):113–115. https://doi.org/10.1007/BF03350660 CrossRef

38.

van Schaardenburg D, Roelfsema F, van Seters AP, Vielvoye GJ (1989) Bromocriptine therapy for non-functioning pituitary adenoma. Clin Endocrinol 30(5):475–484CrossRef

39.

Pivonello R, Matrone C, Filippella M, Cavallo LM, Di Somma C, Cappabianca P, Colao A, Annunziato L, Lombardi G (2004) Dopamine receptor expression and function in clinically nonfunctioning pituitary tumors: comparison with the effectiveness of cabergoline treatment. J Clin Endocrinol Metab 89(4):1674–1683. https://doi.org/10.1210/jc.2003-030859 CrossRefPubMed

40.

Lohmann T, Trantakis C, Biesold M, Prothmann S, Guenzel S, Schober R, Paschke R (2001) Minor tumour shrinkage in nonfunctioning pituitary adenomas by long-term treatment with the dopamine agonist cabergoline. Pituitary 4(3):173–178CrossRefPubMed

41.

Greenman Y, Cooper O, Yaish I, Robenshtok E, Sagiv N, Jonas-Kimchi T, Yuan X, Gertych A, Shimon I, Ram Z, Melmed S, Stern N (2016) Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists. Eur J Endocrinol 175(1):63–72. https://doi.org/10.1530/EJE-16-0206 CrossRefPubMed

42.

de Herder WW, Reijs AE, Feelders RA, van Aken MO, Krenning EP, Tanghe HL, van der Lely AJ, Kwekkeboom DJ (2006) Dopamine agonist therapy of clinically non-functioning pituitary macroadenomas. Is there a role for 123I-epidepride dopamine D2 receptor imaging? Eur J Endocrinol 155(5):717–723. https://doi.org/10.1530/eje.1.02281 CrossRefPubMed

43.

Garcia EC, Naves LA, Silva AO, de Castro LF, Casulari LA, Azevedo MF (2013) Short-term treatment with cabergoline can lead to tumor shrinkage in patients with nonfunctioning pituitary adenomas. Pituitary 16(2):189–194. https://doi.org/10.1007/s11102-012-0403-y CrossRefPubMed

44.

Vieira Neto L, Wildemberg LE, Moraes AB, Colli LM, Kasuki L, Marques NV, Gasparetto EL, de Castro M, Takiya CM, Gadelha MR (2015) Dopamine receptor subtype 2 expression profile in nonfunctioning pituitary adenomas and in vivo response to cabergoline therapy. Clin Endocrinol 82(5):739–746. https://doi.org/10.1111/cen.12684 CrossRef

45.

Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G (2007) Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med 356(1):39–46. https://doi.org/10.1056/NEJMoa054830 CrossRefPubMed

46.

Auriemma RS, Grasso LF, Pivonello R, Colao A (2016) The safety of treatments for prolactinomas. Exp Opin Drug Saf 15(4):503–512. https://doi.org/10.1517/14740338.2016.1151493 CrossRef

47.

Caputo C, Prior D, Inder WJ (2015) The need for annual echocardiography to detect cabergoline-associated valvulopathy in patients with prolactinoma: a systematic review and additional clinical data. The Lancet 3(11):906–913. https://doi.org/10.1016/S2213-8587(14)70212-8 PubMed

48.

Eigler T, Ben-Shlomo A (2014) Somatostatin system: molecular mechanisms regulating anterior pituitary hormones. J Mol Endocrinol 53(1):R1–R19. https://doi.org/10.1530/JME-14-0034 CrossRefPubMed

49.

Colao A, Pivonello R, Di Somma C, Savastano S, Grasso LF, Lombardi G (2009) Medical therapy of pituitary adenomas: effects on tumor shrinkage. Rev Endocr Metab Disord 10(2):111–123. https://doi.org/10.1007/s11154-008-9107-z CrossRefPubMed

50.

Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, Wass JA (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99(11):3933–3951. https://doi.org/10.1210/jc.2014-2700 CrossRefPubMed

51.

Nazato DM, Abucham J (2017) Diagnosis and treatment of TSH-secreting adenomas: review of a longtime experience in a reference center. J Endocrinol Investig. https://doi.org/10.1007/s40618-017-0770-3

52.

Nieman LK, Biller BM, Findling JW, Murad MH, Newell-Price J, Savage MO, Tabarin A (2015) Treatment of cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 100(8):2807–2831. https://doi.org/10.1210/jc.2015-1818 CrossRefPubMedPubMedCentral

53.

Lee M, Lupp A, Mendoza N, Martin N, Beschorner R, Honegger J, Schlegel J, Shively T, Pulz E, Schulz S, Roncaroli F, Pellegata NS (2015) SSTR3 is a putative target for the medical treatment of gonadotroph adenomas of the pituitary. Endocr Relat Cancer 22(1):111–119. https://doi.org/10.1530/ERC-14-0472 CrossRefPubMed

54.

Colao A, Di Somma C, Pivonello R, Faggiano A, Lombardi G, Savastano S (2008) Medical therapy for clinically non-functioning pituitary adenomas. Endocr Relat Cancer 15(4):905–915. https://doi.org/10.1677/ERC-08-0181 CrossRefPubMed

55.

Fusco A, Giampietro A, Bianchi A, Cimino V, Lugli F, Piacentini S, Lorusso M, Tofani A, Perotti G, Lauriola L, Anile C, Maira G, Pontecorvi A, De Marinis L (2012) Treatment with octreotide LAR in clinically non-functioning pituitary adenoma: results from a case-control study. Pituitary 15(4):571–578. https://doi.org/10.1007/s11102-011-0370-8 CrossRefPubMed

56.

Zawada NB, Kunert-Radek J, Pawlikowski M, Pisarek H, Radek M (2016) An evaluation of the effects of somatostatin analogue therapy in non-functioning pituitary adenomas in comparison to acromegaly. Endokrynol Polska 67(3):292–298. https://doi.org/10.5603/EP.a2016.0043

57.

Zatelli MC, Piccin D, Bottoni A, Ambrosio MR, Margutti A, Padovani R, Scanarini M, Taylor JE, Culler MD, Cavazzini L, degli Uberti EC (2004) Evidence for differential effects of selective somatostatin receptor subtype agonists on alpha-subunit and chromogranin a secretion and on cell viability in human nonfunctioning pituitary adenomas in vitro. J Clin Endocrinol Metab 89(10):5181–5188. https://doi.org/10.1210/jc.2003-031954 CrossRefPubMed

58.

Ibanez-Costa A, Rivero-Cortes E, Vazquez-Borrego MC, Gahete MD, Jimenez-Reina L, Venegas-Moreno E, de la Riva A, Arraez MA, Gonzalez-Molero I, Schmid HA, Maraver-Selfa S, Gavilan-Villarejo I, Garcia-Arnes JA, Japon MA, Soto-Moreno A, Galvez MA, Luque RM, Castano JP (2016) Octreotide and pasireotide (dis)similarly inhibit pituitary tumor cells in vitro. J Endocrinol 231(2):135–145. https://doi.org/10.1530/JOE-16-0332 CrossRefPubMed

59.

Ciato D, Mumbach AG, Paez-Pereda M, Stalla GK (2017) Currently used and investigational drugs for cushings disease. Exp Opin Investig Drugs 26(1):75–84. https://doi.org/10.1080/13543784.2017.1266338 CrossRef

60.

Priola SM, Esposito F, Cannavo S, Conti A, Abbritti RV, Barresi V, Baldari S, Ferrau F, Germano A, Tomasello F, Angileri FF (2017) Aggressive pituitary adenomas: the dark side of the moon. World Neurosurg 97:140–155. https://doi.org/10.1016/j.wneu.2016.09.092 CrossRefPubMed

61.

De Caro MDB, Solari D, Pagliuca F, Villa A, Guadagno E, Cavallo LM, Colao A, Pettinato G, Cappabianca P (2017) A typical pituitary adenomas: clinical characteristics and role of ki-67 and p53 in prognostic and therapeutic evaluation. A series of 50 patients. Neurosurg Rev 40(1):105–114. https://doi.org/10.1007/s10143-016-0740-9 CrossRef

62.

Halevy C, Whitelaw BC (2017) How effective is temozolomide for treating pituitary tumours and when should it be used? Pituitary 20(2):261–266. https://doi.org/10.1007/s11102-016-0745-y CrossRefPubMed

63.

Hirohata T, Asano K, Ogawa Y, Takano S, Amano K, Isozaki O, Iwai Y, Sakata K, Fukuhara N, Nishioka H, Yamada S, Fujio S, Arita K, Takano K, Tominaga A, Hizuka N, Ikeda H, Osamura RY, Tahara S, Ishii Y, Kawamata T, Shimatsu A, Teramoto A, Matsuno A (2013) DNA mismatch repair protein (MSH6) correlated with the responses of atypical pituitary adenomas and pituitary carcinomas to temozolomide: the national cooperative study by the Japan Society for Hypothalamic and Pituitary Tumors. J Clin Endocrinol metab 98(3):1130–1136. https://doi.org/10.1210/jc.2012-2924 CrossRefPubMed

64.

Campdera M, Palacios N, Aller J, Magallon R, Martin P, Saucedo G, Lilienfeld H, Estrada J (2016) Temozolomide for aggressive ACTH pituitary tumors: failure of a second course of treatment. Pituitary 19(2):158–166. https://doi.org/10.1007/s11102-015-0694-x CrossRefPubMed

65.

Raverot G, Castinetti F, Jouanneau E, Morange I, Figarella-Branger D, Dufour H, Trouillas J, Brue T (2012) Pituitary carcinomas and aggressive pituitary tumours: merits and pitfalls of temozolomide treatment. Clin Endocrinol 76(6):769–775. https://doi.org/10.1111/j.1365-2265.2012.04381.x CrossRef

66.

Raverot G, Sturm N, de Fraipont F, Muller M, Salenave S, Caron P, Chabre O, Chanson P, Cortet-Rudelli C, Assaker R, Dufour H, Gaillard S, Francois P, Jouanneau E, Passagia JG, Bernier M, Cornelius A, Figarella-Branger D, Trouillas J, Borson-Chazot F, Brue T (2010) Temozolomide treatment in aggressive pituitary tumors and pituitary carcinomas: a French multicenter experience. J Clin Endocrinol Metab 95(10):4592–4599. https://doi.org/10.1210/jc.2010-0644 CrossRefPubMed

67.

McCormack AI, Wass JA, Grossman AB (2011) Aggressive pituitary tumours: the role of temozolomide and the assessment of MGMT status. Eur J Clin Investig 41(10):1133–1148. https://doi.org/10.1111/j.1365-2362.2011.02520.x CrossRef

68.

Raverot G, Burman P, McCormack A, Heaney A, Petersenn S, Popovic V, Trouillas J, Dekkers OM (2018) European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol 178(1):G1–G24. https://doi.org/10.1530/EJE-17-0796 CrossRef

69.

Fani M, Nicolas GP, Wild D (2017) Somatostatin receptor antagonists for imaging and therapy. J Nucl Med 58(Suppl 2):61S–66S. https://doi.org/10.2967/jnumed.116.186783

70.

Komor J, Reubi JC, Christ ER (2014) Peptide receptor radionuclide therapy in a patient with disabling non-functioning pituitary adenoma. Pituitary 17(3):227–231. https://doi.org/10.1007/s11102-013-0494-0 CrossRefPubMed

71.

Baldari S, Ferrau F, Alafaci C, Herberg A, Granata F, Militano V, Salpietro FM, Trimarchi F, Cannavo S (2012) First demonstration of the effectiveness of peptide receptor radionuclide therapy (PRRT) with 111In-DTPA-octreotide in a giant PRL-secreting pituitary adenoma resistant to conventional treatment. Pituitary 15(Suppl 1):S57–S60. https://doi.org/10.1007/s11102-011-0373-5 CrossRefPubMed

72.

Maclean J, Aldridge M, Bomanji J, Short S, Fersht N (2014) Peptide receptor radionuclide therapy for aggressive atypical pituitary adenoma/carcinoma: variable clinical response in preliminary evaluation. Pituitary 17(6):530–538. https://doi.org/10.1007/s11102-013-0540-y CrossRefPubMed

Titel: Management of NFAs: medical treatment
verfasst von: Naomi Even-Zohar
Yona Greenman
Publikationsdatum: 17.01.2018
Verlag: Springer US
Erschienen in: Pituitary / Ausgabe 2/2018
Print ISSN: 1386-341X
Elektronische ISSN: 1573-7403
DOI: https://doi.org/10.1007/s11102-018-0865-7

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

19.04.2024 | Vorhofflimmern | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Management of NFAs: medical treatment

Abstract

Introduction

Methods

Results

Conclusions

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Denken Sie bei starker Blutung auch an die Hemmkörper-Hämophilie

Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Introduction

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2018

Silent corticotroph adenomas

How non-functioning pituitary adenomas can affect health-related quality of life: a conceptual model and literature review

Mortality in patients with non-functioning pituitary adenoma

Silent somatotroph pituitary adenomas: an update

Malignant transformation in non-functioning pituitary adenomas (pituitary carcinoma)

Management of nonfunctioning pituitary tumors: radiotherapy

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Denken Sie bei starker Blutung auch an die Hemmkörper-Hämophilie

Update Innere Medizin