Role of surgery in the management of pituitary tumors.

Growth characteristics and size, irrespective of endocrine activity, predict the nonendocrine clinical presentation of a pituitary adenoma. Anatomic classification by degree of sellar destruction (grade) and extrasellar extension (stage) has value in determining prognosis and in designing therapy, and magnetic resonance imaging provides optimal diagnostic information. The transsphenoidal approach is the preferred surgical technique for most pituitary adenomas and the treatment of choice for those secreting growth hormone (acromegaly) or adrenocorticotropic hormone (Cushing's disease, Nelson's syndrome) and certain nonsecreting tumors. Opinions differ on the initial treatment for prolactin-secreting adenomas; whether most patients should be treated medically or surgically and whether bromocriptine or irradiation should be reserved for surgical failures are still being debated. From experience in a series of 1813 pituitary adenomas, the author surveys tumors of the pituitary region and the role surgery plays in their management.