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      Advancing Treatment of Pituitary Adenomas through Targeted Molecular Therapies: The Acromegaly and Cushing Disease Paradigms

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          Abstract

          The current treatment of pituitary adenomas requires a balance of conservative management, surgical resection, and in select tumor types, molecular therapy. Acromegaly treatment is an evolving field where our understanding of molecular targets and drug therapies has improved treatment options for patients with excess growth hormone levels. We highlight the use of molecular therapies in this disease process and advances in this field, which may represent a paradigm shift for the future of pituitary adenoma treatment.

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          Most cited references66

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          The prevalence of pituitary adenomas: a systematic review.

          Pituitary adenomas display an array of hormonal and proliferative activity. Once primarily classified according to size (microadenomas, or = 1 cm), these tumors are now further classified according to immunohistochemistry and functional status. With these additional classifications in mind, the goals of the current study were to determine the prevalence of pituitary adenomas and to explore the clinical relevance of the findings. The authors conducted a metaanalysis of all existing English-language articles in MEDLINE. They used the search string (pituitary adenoma or pituitary tumor) and prevalence and selected relevant autopsy and imaging evaluation studies for inclusion. The authors found an overall estimated prevalence of pituitary adenomas of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies). Given the high frequency of pituitary adenomas and their potential for causing clinical pathologies, the findings of the current study suggest that early diagnosis and treatment of pituitary adenomas should have far-reaching benefits.
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            Medical progress: Acromegaly.

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              Guidelines for acromegaly management: an update.

              The Acromegaly Consensus Group reconvened in November 2007 to update guidelines for acromegaly management. The meeting participants comprised 68 pituitary specialists, including neurosurgeons and endocrinologists with extensive experience treating patients with acromegaly. EVIDENCE/CONSENSUS PROCESS: Goals of treatment and the appropriate imaging and biochemical and clinical monitoring of patients with acromegaly were enunciated, based on the available published evidence. The group developed a consensus on the approach to managing acromegaly including appropriate roles for neurosurgery, medical therapy, and radiation therapy in the management of these patients.
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/305949
                URI : http://frontiersin.org/people/u/51458
                Journal
                Front Surg
                Front Surg
                Front. Surg.
                Frontiers in Surgery
                Frontiers Media S.A.
                2296-875X
                28 July 2016
                2016
                : 3
                : 45
                Affiliations
                [1] 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center , Phoenix, AZ, USA
                Author notes

                Edited by: Ziya Levent Gokaslan, Brown University, USA

                Reviewed by: Manish Singh Sharma, Mayo Clinic Health System, USA; Amgad Hanna, University of Wisconsin-Madison, USA; Leonardo Welling, Ponta Grossa State University, Brazil

                *Correspondence: Andrew S. Little, neuropub@ 123456dignityhealth.org

                Specialty section: This article was submitted to Neurosurgery, a section of the journal Frontiers in Surgery

                Article
                10.3389/fsurg.2016.00045
                4963385
                27517036
                4f9887c1-5817-473d-b64b-097ff9eec9df
                Copyright © 2016 Mooney, Simon and Little.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 31 March 2016
                : 12 July 2016
                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 69, Pages: 7, Words: 5801
                Categories
                Surgery
                Mini Review

                acromegaly,cushing disease,endonasal,pituitary adenoma,transsphenoidal

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