Decoding pituitary tumors: a systematic analysis of diagnostic methods and treatment modalities


  • Pruthvi Bandari Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B. G. Nagara, Karnataka, India
  • Rosheni R. K. Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B. G. Nagara, Karnataka, India
  • Medhini H. Gowda Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B. G. Nagara, Karnataka, India
  • Gangineni Sri Sai Anwitha Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B. G. Nagara, Karnataka, India
  • Kumaraswamy M. Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B. G. Nagara, Karnataka, India
  • Surabhi K. S. Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B. G. Nagara, Karnataka, India



Pituitary tumors, Transsphenoidal surgery, Radiation therapy, Magnetic resonance spectroscopy, Spoiled gradient echo 3d t1 sequence, CSF leakage


Pituitary tumors are growths that form in the gland these tumors are rare representing 10-15% of all brain tumors. They can disrupt the production of hormones, in the body leading to symptoms related to hormone imbalance. This review offers an overview of the methods used for diagnosing and treating tumors. It is worth noting that relying solely on references may restrict the scope and depth of discussions about tumors in this paper. Suggestions for research include exploring diagnostic tools like molecular imaging and liquid biopsy to enhance early detection and accurate assessment of these tumors. Additionally, more research is required to understand the long-term effects and quality of life outcomes for patients undergoing treatment options for tumors. In conclusion, significant progress has been made in diagnosing and treating tumors over time. Advances in imaging technologies such as diffusion-weighted imaging and magnetic resonance spectroscopy have enhanced precision and treatment strategies for these tumors. The discussion also covers the roles of surgery, radiation therapy and medical interventions, in managing tumor growth and hormonal imbalances further advancements, in research and innovation are crucial, for enhancing our knowledge and treatment of tumors ultimately bringing outcomes for both patients and healthcare professionals. 


Júnior RMPD, Bueno AC, Martins CS, Coelli-Lacchini F, Ozaki JGO, Almeida-E-Silva DC, et al. Integrating Methylome and Transcriptome Signatures Expands the Molecular Classification of the Pituitary Tumors. J Clin Endocrinol Metab. 2023;108(6):1452-63.

Castellanos LE, Gutierrez C, Smith T, Laws ER, Iorgulescu JB. Epidemiology of common and uncommon adult pituitary tumors in the U.S. according to the 2017 World Health Organization classification. Pituitary. 2022;25(1):201-9.

Raverot G. Aggressive Pituitary Adenomas. Pituitary. 20221;637-48.

Vries F, Lobatto DJ, Verstegen MJT, Schutte PJ, Notting IC, Kruit MC, et al. Outcome Squares Integrating Efficacy and Safety, as Applied to Functioning Pituitary Adenoma Surgery. J Clin Endocrinol Metab. 2021;106(9):e3300-11.

McCormack A, Dekkers OM, Petersenn S, Popovic V, Trouillas J, Raverot G, et al. Treatment of aggressive pituitary tumours and carcinomas: results of a European Society of Endocrinology (ESE) survey 2016. Eur J Endocrinol. 2018;178(3):265-76.

Batista RL, Musolino NRC, Cescato VAS, da Silva GO, Medeiros RSS, Herkenhoff CGB, et al. Cabergoline in the Management of Residual Nonfunctioning Pituitary Adenoma: A Single-Center, Open-Label, 2-Year Randomized Clinical Trial. Am J Clin Oncol. 2019;42(2):221-7.

Khan DZ, Hanrahan JG, Baldeweg SE, Dorward NL, Stoyanov D, Marcus HJ. Current and Future Advances in Surgical Therapy for Pituitary Adenoma. Endocr Rev. 2023;44(5):947-59.

Barkhoudarian G, Kelly DF. The Pituitary Gland: Anatomy, Physiology, and its Function as the Master Gland. Cushing’s Disease: An Often Misdiagnosed and Not So Rare Disorder. Elsevier; 2017: 1-41.

Tsutsumi S, Hori M, Ono H, Tabuchi T, Aoki S, Yasumoto Y. The Infundibular Recess Passes through the Entire Pituitary Stalk. Clin Neuroradiol. 2016;26(4):465-69.

Ilahi S, Ilahi TB. Anatomy, Adenohypophysis (Pars Anterior, Anterior Pituitary). 2022. Treasure Island: StatPearls Publishing; 2024.

Mei Y, Bi WL, Greenwald NF, Du Z, Agar NY, Kaiser UB, et al. Increased expression of programmed death ligand 1 (PD-L1) in human pituitary tumors. Oncotarget. 2016;7(47):76565-6.

Litwack G. The hypothalamus and anterior pituitary. Hormones. 2022;57-89.

Scanes CG. Pituitary gland. Sturkie’s Avian Physiology. 2022;759-813.

Norman AW, Henry HL. Posterior Pituitary Hormones. Hormones. 2015;81-8.

Litwack G. Posterior pituitary hormones. Hormones. 2022;91-100.

Hoermann R, Pekker MJ, Midgley JEM, Dietrich JW. The role of supporting and disruptive mechanisms of FT3 homeostasis in regulating the hypothalamic-pituitary-thyroid axis. Ther Adv Endocrinol Metab. 2023 Mar 14;14:20420188231158163.

Nasi-Kordhishti I, Giese S, Hirt B, Honegger J. Anatomy of the pituitary region. Pituitary Tumors. 2021;67-85.

Sun X, Huo L, Wang X, Zhang C, Zhao A. Comprehensive clinical analysis of patients with primary malignant tumor of pituitary gland: A population-based study. Front Surg. 2022;9:933168.

Makarenko S, Alzahrani I, Karsy M, Deopujari C, Couldwell WT. Outcomes and surgical nuances in management of giant pituitary adenomas: a review of 108 cases in the endoscopic era. J Neurosurg. 2022:1-12.

Raymond P, Raverot G, Ilie MD. Outcome and prognostic factors for pituitary carcinomas: lessons from a systematic review. Endocr Relat Cancer. 2023;30(5):e220338.

Sahakian N, Appay R, Resseguier N, Graillon T, Piazzola C, Laure C, et al. Real-life clinical impact of a five-tiered classification of pituitary tumors. Eur J Endocrinol. 2022;187(6):893-904.

Mete O, Lopes B, Roncaroli F, Tihan T, Yamada S. Pituitary Gland: Primary Gliomas Int Agency Res Cancer. 2017.

Frampton G, Whaley P, Bennett M, Bilotta G, Dorne JLCM, Eales J, et al. Principles and framework for assessing the risk of bias for studies included in comparative quantitative environmental systematic reviews. Environ Evid. 2022;11(1).

Zhou J, Guo X, Duan L, Yao Y, Shang Y, Wang Y, et al. Moving toward a standardized diagnostic statement of pituitary adenoma using an information extraction model: a real-world study based on electronic medical records. BMC Med Inform Decis Mak. 2022;22(1):319.

Haddaway NR, Rethlefsen ML, Davies M, Glanville J, McGowan B, Nyhan K, et al. A suggested data structure for transparent and repeatable reporting of bibliographic searching. Campbell Syst Rev. 2022;18(4):e1288.

Wu Y, Wu Y. New Progress in Imaging of Pituitary Diseases. Neuroimaging - New Insights. Intech Open. 2024.

Bender B, Honegger J. Morphological imaging including imaging anatomy. Pituitary Tumors. 2021;89-102.

Perosevic M, Jones PS, Tritos NA. Magnetic resonance imaging of the hypothalamo-pituitary region. Handb Clin Neurol. 2021;179:95-112.

Sasagawa Y, Nakahara M, Takemoto D, Nakada M. Optical coherence tomography detects early optic nerve damage before visual field defect in patients with pituitary tumors. Neurosurg Rev. 2023;46(1):85.

Shaikh HA, Arain SH, Rehman L, Hashmi ASM. Visual disturbances in patients with pituitary tumors and early improvement of visual acuity and visual field defects after resection of pituitary tumors. Profl Med J. 2021;28(9):1257-61.

Castle-Kirszbaum M, Wang YY, King J, Goldschlager T. Predictors of visual and endocrine outcomes after endoscopic transsphenoidal surgery for pituitary adenomas. Neurosurg Rev. 2022;45(1):843-53.

Gaillard S, Adeniran S, Villa C, Jouinot A, Raffin-Sanson ML, Feuvret L, et al. Outcome of giant pituitary tumors requiring surgery. Front Endocrinol (Lausanne). 2022;13:975560.

Shen J, Zhang W, Zhu JJ, Xue L, Yuan M, Xu H, et al. Multiparametric Magnetic Resonance Imaging for Assessing Thymic Epithelial Tumors: Correlation With Pathological Subtypes and Clinical Stages. J Magn Reson Imaging. 2022;56(5):1487-96.

Hinojosa-Amaya JM, Varlamov EV, McCartney S, Fleseriu M. Pituitary magnetic resonance imaging use in the posttreatment follow-up of secreting pituitary adenomas. Pituitary Tumors: A Comprehensive and Interdisciplinary Approach. Elsevier: 2021; 447-55.

Zhou Q, Huang X, Xue C, Zhou J. Correlation of clinical and computed tomography features of thymic epithelial tumours with World Health Organization classification and Masaoka-Koga staging. Eur J Cardiothorac Surg. 2022;61(4):742-8.

Ijare OB, Holan C, Hebert J, Sharpe MA, Baskin DS, Pichumani K. Elevated levels of circulating betahydroxybutyrate in pituitary tumor patients may differentiate prolactinomas from other immunohistochemical subtypes. Sci Rep. 2020;10(1):1334.

Anderson AJ, Denniss J, McKendrick AM. Visual field testing: how frequent is frequent enough, and other developments. Sci Glaucoma Manag. 2023;135-45.

Ito M, Suda K, Nakano E, Tagawa M, Miyata M, Kashii S, et al. Influence of Tumor Characteristics on Visual Field Outcomes After Pituitary Adenoma Surgery. J Neuroophthalmol. 2023;43(3):376-82.

Thon N, Karschnia P, Baumgarten L, Niyazi M, Steinbach JP, Tonn JC. Neurosurgical Interventions for Cerebral Metastases of Solid Tumors. Dtsch Arztebl Int. 2023;120(10):162-9.

Carapella CM, Gorgoglione N, Oppido PA. The role of surgical resection in patients with brain metastases. Curr Opin Oncol. 2018;30(6):390-5.

Lee SJ, Hwang SC, Im SB, Kim BT. Surgical Resection of Non-Glial Tumors in the Motor Cortex. Brain Tumor Res Treat. 2016;4(2):70-6.

Asmaro KP, Mohyeldin A, Vigo V, Nunez MA, Fernandez-Miranda J. The Diagnostic Accuracy of Magnetic Resonance Imaging in Predicting Cavernous Sinus Invasion of Pituitary Tumors. J Neurol Surg B Skull Base. 2022;83(1):22.

Mamelak AN. Pituitary Surgery. Pituitary. 2022;723-52.

Perondi G, Mariante A, Azambuja F, Greggianin GF, Dias WW dos S, Pinzetta G. Endoscopic Transsphenoidal Surgery of Pituitary Adenomas: Preliminary Results of the Neurosurgery Service of Hospital Cristo Redentor. Brazilian Neurosurg. 2023;42(02):e89-100.

Nie D, Fang Q, Wong W, Gui S, Zhao P, Li C, et al. The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis. World J Surg Oncol. 2023;21(1):71.

Saad M, Taha AN, Serag S, Shata H, Zakaria WK. Giant invasive pituitary adenomas: surgical approach selection paradigm and its influence on the outcome- case series. Egyptian J Neurosurg. 2023;38:1.

England RJA, Shamil E, Mathew R, Bance M, Surda P, Jose J, et al. Scott-Brown’s Essential Otorhinolaryngology. Scott-Brown’s Essential Otorhinolaryngology. CRC Press; 2022.

Kowalchuk RO, Trifiletti DM, Brown PD, Sheehan JP. Contemporary radiotherapy and radiosurgery techniques for refractory pituitary adenomas. Pituitary. 2023;26(3):298-302.

Heckman P, Hao Z, Bernard ME, Chen Q, Huang B. Survival outcomes of stage I small cell lung cancer (SCLC) treated with stereotactic body radiation therapy (SBRT) versus external beam radiation therapy (EBRT): An NCDB analysis. J Clin Oncol. 2024;41(6):38.

Jia-Mahasap B, Madla C, Sripan P, Chitapanarux I, Tharavichitkul E, Chakrabandhu S, et al. Stereotactic radiosurgery for limited brain metastasis using three different techniques: helical tomotherapy, volumetric modulated arc therapy, and cone-based LINAC radiosurgery. Radiat Oncol J. 2022;40(4):232-41.

Shenker RF, Johnson TL, Ribeiro M, Rodrigues A, Chino J. Estimating Carbon Dioxide Emissions and Direct Power Consumption of Linear Accelerator-Based External Beam Radiation Therapy. Adv Radiat Oncol. 2022;8(3):101170.

Begalli F, Botta J, Collier D, Dorward N, Grieve J, Khan D, et al. PMON170 Treating human primary non-functioning pituitary adenoma cells with cabergoline. J Endocr Soc. 2022;6(1):A548-9.

Arora V, Kabra A, Puri R, Vyas G, Dua K, Dureja H. Emerging drug delivery in the treatment of hyperpituitarism and hypopituitarism. Drug DelivSys Metab Disord. 2022;249-57.

Hamblin R, Fountas A, Lithgow K, Loughrey PB, Bonanos E, Shinwari SK, et al. Natural history of non-functioning pituitary microadenomas: results from the UK non-functioning pituitary adenoma consortium. Eur J Endocrinol. 2023;189(1):87-95.

Sheldon BL, O'Brien MW, Adamo MA. Growth hormone replacement therapy: is it safe to use in children with asymptomatic pituitary lesions? J Pediatr Endocrinol Metab. 2021;34(12):1525-9.

Borghammar C, Tamaddon A, Erfurth EM, Sundgren PC, Siesjö P, Elfving M, et al. Non-functioning pituitary microadenoma in children and adolescents: Is follow-up with diagnostic imaging necessary? Endocrine. 2023;79(1):152-60.

Exarchou K, Moore AR, Smart HL, Duckworth CA, Howes N, Pritchard DM. A "Watch and Wait" Strategy Involving Regular Endoscopic Surveillance Is Safe for Many Patients with Small, Sporadic, Grade 1, Non-Ampullary, Non-Functioning Duodenal Neuroendocrine Tumours. Neuroendocrinology. 2021;111(8):764-74.

Madan R, Yadav A, Goyal S. Pituitary Tumors: Diagnosis and Management. Evidence based practice in Neuro-oncology. 2021;16(3):475-828.

Lenders NF, Chui J, Low J, Inder WJ, Earls PE, McCormack AI. Development of a cost-effective diagnostic algorithm incorporating transcription factor immunohistochemistry in the evaluation of pituitary tumours. Pituitary. 2022 D;25(6):997-1003.

Maya M, Pressman BD. Pituitary Imaging. The Pituitary. 4th ed. JNM; 2017: 645-669.

Adinegoro AF, Sutapa GN, Gunawan AAN, Anggarani NKN, Suardana P, Kasmawan IGA. Classification and Segmentation of Brain Tumor Using EfficientNet-B7 and U-Net. Asian J Res Comp Sci. 2023;15(3):1-9.

Mehta GU, McCutcheon IE. Stereotactic Radiosurgery for Pituitary Carcinoma. Acta Neurochir Suppl. 2021;128:43-49.

Burman P, Casar-Borota O, Perez-Rivas LG, Dekkers OM. Aggressive Pituitary Tumors and Pituitary Carcinomas: From Pathology to Treatment. J Clin Endocrinol Metab. 2023;108(7):1585-601.

Yu R. Neuroendocrine Tumor Syndromes. Endocrinology: Adult and Pediatric. 2016;2:2606-14.

Zhang F, Zhang Q, Zhu J, Yao B, Ma C, Qiao N, et al. Integrated proteogenomic characterization across major histological types of pituitary neuroendocrine tumors. Cell Res. 2022;32(12):1047-67.

Tebani A, Jotanovic J, Hekmati N, Sivertsson Å, Gudjonsson O, Edén Engström B, et al. Annotation of pituitary neuroendocrine tumors with genome-wide expression analysis. Acta Neuropathol Commun. 2021;9(1):181.

Karamouzis I, Caputo M, Mele C, Nuzzo A, Zavattaro M, Car P, et al. Transsphenoidal surgery for pituitary adenomas: early results from a single center. Hormones (Athens). 2018;17(4):551-6.

Amador JL, Martínez-Anda JJ, Guerrero-Suarez PD, Rosales-Amaya AM, Delgado-Arce JC, Guerrero-López DA. Endoscopic endonasal lateral transellar approach for growth hormone-secreting adenomas with cavernous sinus invasion: Technical note and surgical results. Neurocirugia (Astur : Engl Ed). 2021;32(4):170-7.

Luo M, Tan Y, Chen W, Hu B, Wang Z, Zhu D, et al. Clinical Efficacy of Temozolomide and Its Predictors in Aggressive Pituitary Tumors and Pituitary Carcinomas: A Systematic Review and Meta-Analysis. Front Neurol. 2021;12:700007.

Ng S, Fomekong F, Delabar V, Jacquesson T, Enachescu C, Raverot G, et al. Current status and treatment modalities in metastases to the pituitary: a systematic review. J Neurooncol. 2020;146(2):219-27.

Su CQ, Zhang X, Pan T, Chen XT, Chen W, Duan SF, et al. Texture Analysis of High b-Value Diffusion-Weighted Imaging for Evaluating Consistency of Pituitary Macroadenomas. J Magn Reson Imaging. 2020;51(5):1507-13.

Hu J, Yan J, Zheng X, Zhang Y, Ran Q, Tang X, et al. Magnetic resonance spectroscopy may serve as a presurgical predictor of somatostatin analog therapy response in patients with growth hormone-secreting pituitary macroadenomas. J Endocrinol Invest. 2019;42(4):443-51.

Grober Y, Grober H, Wintermark M, Jane JA, Oldfield EH. Comparison of MRI techniques for detecting microadenomas in Cushing's disease. J Neurosurg. 2018;128(4):1051-7.

Khant ZA, Azuma M, Kadota Y, Hattori Y, Takeshima H, Yokogami K, et al. Evaluation of pituitary structures and lesions with turbo spin-echo diffusion-weighted imaging. J Neurol Sci. 2019;405:116390.

Han R, Shen L, Zhang J, Xie J, Fang W, Sun Q, et al. Diagnosing Thyrotropin-Secreting Pituitary Adenomas by Short-Term Somatostatin Analogue Test. Thyroid. 2020;30(9):1236-44.

Nishioka H, Inoshita N, Mete O, Asa SL, Hayashi K, Takeshita A, et al. The Complementary Role of Transcription Factors in the Accurate Diagnosis of Clinically Nonfunctioning Pituitary Adenomas. Endocr Pathol. 2015;26(4):349-55.

Kwinta BM, Krzyżewski RM, Kliś K, Adamek D. Quantitative immunohistochemical assessment of clinically non-functioning pituitary adenomas. Med Res J. 2018;2(4):147-51.

Sasagawa Y, Nakahara M, Takemoto D, Nakada M. Optical coherence tomography detects early optic nerve damage before visual field defect in patients with pituitary tumors. Neurosurg Rev. 2023;46(1):85.

Liang L, Lin H, Lin F, Yang J, Zhang H, Zeng L, et al. Quantitative visual pathway abnormalities predict visual field defects in patients with pituitary adenomas: a diffusion spectrum imaging study. Eur Radiol. 2021;31(11):8187-96.

Cohen-Cohen S, Helal A, Yin Z, Ball MK, Ehman RL, Van Gompel JJ, et al. Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography. J Neurosurg. 2021;136(5):1356-63.

Xu P, Liu S, Dong Y, Liang W, Li Z, Liu F. Effects of nasal irrigation after endoscopic transsphenoidal resection in patients with pituitary adenomas: A randomized controlled trial. Medicine (Baltimore). 2021;100(51):e28317.

Xu P, Liu S, Dong Y, Liang W, Li Z, Liu F. Effects of nasal irrigation after endoscopic transsphenoidal resection in patients with pituitary adenomas: A randomized controlled trial. Medicine (Baltimore). 2021;100(51):e28317.

Yu SY, Du Q, Yao SY, Zhang KN, Wang J, Zhu Z, et al. Outcomes of endoscopic and microscopic transsphenoidal surgery on non-functioning pituitary adenomas: a systematic review and meta-analysis. J Cell Mol Med. 2018;22(3):2023-7.

Layard Horsfall H, Lawrence A, Venkatesh A, Loh RTS, Jayapalan R, Koulouri O, et al. Reported outcomes in transsphenoidal surgery for pituitary adenomas: a systematic review. Pituitary. 2023;26(2):171-81.

Zaidi HA, Awad AW, Bohl MA, Chapple K, Knecht L, Jahnke H, et al. Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. J Neurosurg. 2016;124(3):596-604.

Zhou Z, Zuo F, Chen X, Zhao Q, Luo M, Jiang X, et al. Risk factors for postoperative cerebrospinal fluid leakage after transsphenoidal surgery for pituitary adenoma: a meta-analysis and systematic review. BMC Neurol. 2021;21(1):417.

Liu J, Li C, Xiao Q, Gan C, Chen X, Sun W, et al. Comparison of Pituitary Adenomas in Elderly and Younger Adults: Clinical Characteristics, Surgical Outcomes, and Prognosis. J Am Geriatr Soc. 2015;63(9):1924-30.

Wilson PJ, Omay SB, Kacker A, Anand VK, Schwartz TH. Endonasal endoscopic pituitary surgery in the elderly. J Neurosurg. 2018;128(2):429-36.

Gondim JA, Almeida JP, de Albuquerque LA, Gomes E, Schops M, Mota JI. Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas. J Neurosurg. 2015;123(1):31-8.

Chinezu R, Fomekong F, Lasolle H, Trouillas J, Vasiljevic A, Raverot G, et al. Risks and Benefits of Endoscopic Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas in Patients of the Ninth Decade. World Neurosurg. 2017;106:315-21.




How to Cite

Bandari, P., R. K., R., Gowda, M. H., Anwitha, G. S. S., M., K., & K. S., S. (2024). Decoding pituitary tumors: a systematic analysis of diagnostic methods and treatment modalities. International Journal of Research in Medical Sciences, 12(5), 1647–1658.



Systematic Reviews