Abstract
Pituitary adenomas are the most frequent tumors in the sellar region. Treatment of pituitary adenomas is a complex issue, which includes neurosurgical, pharmacological and radiation treatment modalities.
The most common first-line treatment for pituitary adenomas is neurosurgery. The exception is prolactinomas where the pharmacological therapy with dopamine agonists is the first-line treatment.
In acromegaly and Cushing's disease radiosurgery with Leksell Gamma Knife (LGN) is used mainly as a secondary treatment of tumor residues after neurosurgery. In prolactinomas the pharmacoresistance is the main indication for radiosurgery.
In functioning pituitary adenomas, pharmacological treatment must be administered only until the effect of the irradiation is evident, not for life. Tumor growth control is achieved in more than 90 % of pituitary adenomas (both functioning and non-functioning).
The most common side effect associated with radiosurgery is the development of hypopituitarism. Hypopituitarism after LGK can be limited by keeping the mean radiation dose to pituitary < 15 Gy a to the distal infundibulum < 17 Gy.