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Diagnosis and management of prolactinomas and non-functioning pituitary adenomas

#### Summary points

Pituitary tumours account for a major proportion of intracranial tumours; most are benign adenomas. The tumours present with a range of signs and symptoms. Although evidence suggests that they are diagnosed earlier than previously, some are still missed, often for years, with clues such as headache and visual problems not being picked up.1 Management by a multidisciplinary team improves outcomes and optimises resources. This article focuses on the diagnosis and management of prolactinomas and non-functioning pituitary adenomas, which are the commonest types of pituitary adenoma in clinical practice.

#### Sources and selection criteria

We searched PubMed to identify peer reviewed original articles and reviews. Search terms were “pituitary tumour”, “pituitary adenoma”, “pituitary neoplasm”, and “prolactinoma”. We only considered those papers that were written in English and published within the past 20 years.

Pituitary adenomas are monoclonal benign tumours that arise from differentiated hormone expressing cells in the anterior pituitary. Five major cell types occur in the anterior pituitary: the lactrotroph, producing prolactin; the somatotroph, producing growth hormone; the corticotroph, producing adrenocorticotrophic hormone; the thyrotroph, producing thyroid stimulating hormone; and the gonadotroph, producing luteinising hormone and follicle stimulating hormone. Classification of pituitary adenomas is based in part on the cell type. Tumours that secrete hormones are called functioning adenomas …