Pituitary Tumor · Medical vs Transsphenoidal vs Craniotomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Type + mass effect/vision + size/invasion
   Functional type? Mass effect/visual loss? Size/invasion?
   • Prolactinoma (no acute visual crisis) → Prolactinoma → dopamine agonist
   • Other functioning (GH/ACTH) or non-functioning with mass effect/chiasmal compression → Functioning/non-functioning mass → transsphenoidal
   • Giant/marked suprasellar or lateral (beyond cavernous sinus) invasion, hard to fully resect endonasally → Giant/lateral invasion → craniotomy
   • Non-functioning microadenoma, no mass effect or hormone abnormality → Non-functioning microadenoma → observe
   • Pituitary apoplexy with acute visual deterioration/neurological deficit → Pituitary apoplexy → emergency decompression
2. [End] Prolactinoma → dopamine agonist
   Prolactinoma → dopamine agonist (cabergoline/bromocriptine) first-line, marked shrinkage; resistance/intolerance/predominantly cystic/progressive visual loss on therapy → transsphenoidal surgery.
3. [End] Functioning/non-functioning mass → transsphenoidal
   Other functioning (acromegaly/Cushing's) or non-functioning with mass effect/chiasmal compression → endoscopic transsphenoidal resection first-line; residual/recurrence → medical (SRL, etc.)/radiotherapy (SRS).
4. [End] Giant/lateral invasion → craniotomy
   Giant/marked suprasellar or lateral invasion, dumbbell-shaped, not reachable endonasally → transcranial (craniotomy) resection or a staged combined approach.
5. [End] Non-functioning microadenoma → observe
   Non-functioning microadenoma, no mass effect or hormone abnormality → observe (serial MRI + endocrine follow-up); manage if it grows or develops function or mass effect.
6. [End] Pituitary apoplexy → emergency decompression
   Pituitary apoplexy + acute visual deterioration/altered consciousness → emergency corticosteroid replacement (hydrocortisone) + early transsphenoidal decompression.

Source guidelines & references

• Pituitary adenoma management (Endocrine Society prolactinoma guideline; transsphenoidal/transcranial approaches)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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