Medical management of pituitary disease.

Success in the treatment of pituitary tumours depends on their size and invasiveness so that early detection is imperative. Immediate cure of microadenomas is assured by trans-sphenoidal microsurgery although longterm results are not yet established. Complete removal of large tumours is less likely and radiotherapy is advised if there is evidence of residual tumour activity. External irradiation is indicated in the treatment of radiosensitive germinomas. Drugs can control symptoms before surgery or while awaiting the effects of radiotherapy but may be the treatment of choice for large prolactinomas. Bromocriptine or other dopamine agonists not only inhibit prolactin secretion but also limit tumour size, but it is not known if they are effective indefinitely. Dynamic tests of pituitary function should precede hormone replacement therapy and careful supervision with monitoring of plasma hormone levels accompany long-term treatment.