title: Management of aggressive growth hormone secreting pituitary adenomas.
abstract: Aggressive GH-secreting pituitary adenomas (GHPAs) represent an important clinical problem in patients with acromegaly. Surgical therapy, although often the mainstay of treatment for GHPAs, is less effective in aggressive GHPAs due to their invasive and destructive growth patterns, and their proclivity for infrasellar invasion. Medical therapies for GHPAs, including somatostatin analogues and GH receptor antagonists, are becoming increasingly important adjuncts to surgical intervention. Stereotactic radiosurgery serves as an important fallback therapy for tumors that cannot be cured with surgery and medications. Data suggests that patients with aggressive and refractory GHPAs are best treated at dedicated tertiary pituitary centers with multidisciplinary teams of neuroendocrinologists, neurosurgeons, radiation oncologists and other specialists who routinely provide advanced care to GHPA patients. Future research will help clarify the defining features of "aggressive" and "atypical" PAs, likely based on tumor behavior, preoperative imaging characteristics, histopathological characteristics, and molecular markers.
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Donoho
authors.affiliation: Division of Endocrinology, Department of Medicine, Keck School of Medicine of the University of Southern California, USC Pituitary Center, 1520 San Pablo Street #3800, Los Angeles, CA, 90033, USA.
authors.forename: Namrata
authors.initials: N
authors.lastname: Bose
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zada
authors.affiliation: Division of Endocrinology, Department of Medicine, Keck School of Medicine of the University of Southern California, USC Pituitary Center, 1520 San Pablo Street #3800, Los Angeles, CA, 90033, USA. john.carmichael@med.usc.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Carmichael
mesh_terms: D000172:Acromegaly / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D000818:Animals; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery
keywords: Acromegaly; Aggressive; Atypical adenoma; Invasive; Pituitary adenoma; Transsphenoidal surgery