Clinically Non-Functioning Pituitary Tumours and Gonadotropinomas

Clinically non-functioning pituitary adenomas (NFPAs) usually present with mass effects. Transsphenoidal surgery is the cornerstone of treatment once there is an indication for decompression. In smaller NFPAs, a wait-and-scan policy is usually considered. After surgery tumour remnants are closely followed with MRI and ophthalmological evaluation. Adjuvant radiotherapy can be performed in case there is a remnant, however, given the slow growth tendency a wait and scan policy and postponing radiotherapy is an alternative approach, especially in patients with normal pituitary function. Recent years there are some innovations with respect to medical treatment. Cabergoline may help with tumour stabilization in a subset of patients and temozolomide can be attempted in aggressive forms of pituitary adenoma.