Pituitary adenomas — now often termed pituitary neuroendocrine tumors (PitNETs) under the updated WHO classification — are managed according to hormone secretion and mass effect. Transsphenoidal surgery is first-line for most functioning and compressive tumors, with the important exception of prolactinomas, where dopamine agonists (cabergoline preferred over bromocriptine) effectively shrink the tumor and normalize prolactin.
For growth-hormone-secreting tumors (acromegaly), somatostatin receptor ligands (octreotide, lanreotide, and pasireotide) and the GH-receptor antagonist pegvisomant remain mainstays — and the notable advance is oral therapy: after oral octreotide (approved 2020), paltusotine (Palsonify), a once-daily oral selective SST2 agonist, was FDA-approved in September 2025 (PATHFNDR-1 and -2 trials) as the first once-daily oral treatment for acromegaly, offering an alternative to injections. For corticotroph tumors (Cushing's disease), pituitary-directed pasireotide is joined by cortisol-synthesis inhibitors (osilodrostat, levoketoconazole, and metyrapone) and the glucocorticoid-receptor blocker mifepristone. For aggressive tumors and pituitary carcinomas, temozolomide is first-line salvage therapy, with immune checkpoint inhibitors and targeted agents (against VEGF, mTOR, and EGFR pathways) under investigation. Stereotactic radiosurgery is reserved for tumors not controlled by surgery or medication.
Further reading: diagnosis and management of pituitary adenomas (Tritos & Miller, JAMA 2023); pituitary-tumor endocrinopathies (Melmed, NEJM 2020); paltusotine PATHFNDR trials and 2025 approval.