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Treatments for pituitary neuroendocrine tumours (PitNETs)
The following are treatment options for pituitary neuroendocrine tumours (PitNETs). Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Treatments vary slightly between the different types of PitNETs. If the tumour makes too many hormones (called a functioning tumour), treatment depends on which hormones are being made.
Drug therapy with dopamine agonists is the main treatment for prolactin-producing tumours (also called prolactinomas). Most prolactin-producing tumours respond well to drug therapy, so it is usually the only treatment needed.
Surgery is sometimes used to treat prolactin-producing tumours when drug therapy doesn’t work or can’t be used. Depending on the size of the tumour, transsphenoidal surgery or a craniotomy is done to remove the tumour.
You may be offered external beam radiation therapy for prolactin-producing tumours. It can be used after surgery or instead of surgery.
Growth hormone–producing tumour
Surgery is a standard treatment for growth hormone–producing tumours. Endoscopic transsphenoidal surgery is usually done to remove the tumour.
Drug therapy is often needed after surgery for growth hormone–producing tumours. A somatostatin analogue lowers growth hormone levels in the body and treats acromegaly (increased growth of the skull and bones of the face, jaw, hands and feet). When somatostatin analogues don’t work to control the symptoms of acromegaly, a growth hormone receptor antagonist is used. It is called pegvisomant (Somavert).
Sometimes drug therapy is given before surgery because it may make it easier for the surgeon to remove the tumour.
You may be offered radiation therapy for growth hormone–producing tumours when surgery can’t be done. Regular external beam radiation therapy or stereotactic radiosurgery can be used.
Adrenocorticotropic hormone (ACTH)–producing tumour
Surgery is usually offered for ACTH-producing tumours. Transsphenoidal surgery is usually done to remove the tumour. A bilateral adrenalectomy to remove both adrenal glands is sometimes done to control hormone levels.
External beam radiation therapy may be used alone when surgery can’t be done or if the tumour comes back (recurs) after it has been treated.
Drug therapy is used if surgery has not controlled Cushing disease and cortisol levels in the body. A somatostatin analogue or steroidogenesis inhibitor is used.
Thyroid-stimulating hormone (TSH)–producing tumour
Surgery is usually offered for TSH-producing tumours. The type of surgery done will depend on the size of the tumour. Your surgeon may find it hard to completely remove the tumour because these tumours often grow into nearby areas.
Radiation therapy may be offered after surgery if there is a high risk that the tumour will come back or to help control the growth of a tumour that wasn’t completely removed. It may also be used to treat tumours that come back after treatment.
Drug therapy with a somatostatin analogue, such as octreotide (Sandostatin), is usually used for TSH-producing tumours. A dopamine agonist, such as bromocriptine (Parlodel), may be used.
Surgery is the first treatment for gonadotropin-producing tumours (also called gonadotroph tumours). The type of surgery done depends on the size of the tumour. Because gonadotropin-producing tumours are usually large tumours that press on nearby areas, surgery helps to relieve and control symptoms. Surgery is usually done again if the tumour comes back.
External beam radiation therapy may be used for a tumour that comes back after it has been treated. It is mainly used when the tumour is growing quickly (aggressive).
Most gonadotrophin-producing tumours are non-functioning and do not release extra hormones. For the rare cases when it is a functioning tumour, drug therapy may be offered. A dopamine agonist, such as bromocriptine, may be used.
Surgery is usually the first treatment for non-functioning tumours. The type of surgery done will depend on the size of the tumour. Because non-functioning tumours are usually large tumours that press on nearby areas, surgery helps to relieve and control symptoms. Surgery is usually done again if the tumour comes back.
Hormone replacement may be needed if the tumour is large and affects how the pituitary gland is working. It replaces any of the hormones that the pituitary gland is not making enough of.
External beam radiation therapy may be used if the non-functioning tumour is growing very quickly.
A few clinical trials in Canada are open to people with PitNETs. Clinical trials look at new ways to find and treat tumours. Find out more about clinical trials.
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