Management of aggressive pituitary adenomas and pituitary carcinomas

Pituitary tumors are benign but not uncommonly invade locally into adjacent tissues such as the cavernous sinus and dura. Some of these invasive tumors exhibit varying degrees of resistance to standard therapy and tend to recur. Early prediction of which pituitary tumors will recur and/or exhibit an invasive phenotype remains difficult despite introduction of several tissue-based molecular markers. Management of these recurrent invasive pituitary tumors usually comprises combination medical, surgical and radiation therapy but in some instances is suboptimal. Earlier diagnosis of invasive/recurrent pituitary tumor and application of aggressive multi-modal therapy at presentation may be advantageous in some cases. Clinical trials to develop additional therapeutic options are needed for this subgroup of pituitary tumors. Although it is not yet possible to diagnose at presentation, the subset of pituitary tumors that will become invasive and/or recurrent pituitary tumors, broader use of molecular markers and standardization of histopathological criteria for “atypical” pituitary tumor features have assisted earlier diagnosis. Aggressive therapy early in disease may be warranted and exploration of recently available targeted therapies may improve disease management.