How are pituitary stalk lesions treated
Because of the rarity of hypophysitis and pituitary stalk lesions, much of the treatment recommendations are based on nonrandomized, retrospective series and are as follows
Treatment Recommendations for Pituitary Stalk Lesions.
|PITUITARY STALK LESIONS||TREATMENT RECOMMENDATIONS|
|Congenital lesions||• No treatment indicated• Replete deficient pituitary hormones, as indicated|
|Pituitary stalk neoplasms (e.g., pituicytoma, germinoma, craniopharyngioma, etc.)||• Subtotal or gross total resection, as indicated• Radiation for residual tumors• Replete deficient pituitary hormones|
|Hypophysitis (primary and secondary)||• Glucocorticoids, alternative immunosuppressive agents, or treatment of systemic diseases• Biopsy/Decompression as indicated (see Table 24.3 )|
|Immunotherapeutic drugs (e.g., ipilimumab > pembrolizumab, nivolumab > atezolizumab, avelumab and durvalumab)||• Glucocorticoids• Replete additional deficient pituitary hormones, as needed• Biopsy rarely needed|