SSA could thus play a role in the management of NFA patients, but outcomes of well-designed placebo-controlled studies are lacking. 17 Indeed, treatment with octreotide seems to prevent tumour progression in selected NFA patients, although interpretation is hampered by methodological heterogeneity among studies and open-label design. 10вЂ“16 The somatostatin analogues (SSA) octreotide and lanreotide have highest affinity for SSTR 2 and SSTR 5, and these subtypes are implicated in antiproliferative effects. The expression of somatostatin receptor (SSTR) subtypes in the majority of NFA provides a potential target for receptor-mediated therapy. 7вЂ“9Д®ffective medical therapy as alternative option in NFA management would therefore be of great value. 5 6 Adjuvant radiotherapy is effective in controlling tumour (re)growth, but its use is restricted in view of the high risk of hypopituitarism and rare but important complications such as optic nerve damage and secondary brain tumours. Repeat surgery is recommended in case of persistent or recurrent chiasm compression, but the benefit/risk ratio is less favourable than with primary surgery. 3 4 Consequently, a substantial part of patients requires additional treatment during follow-up. However, the overall remission rate after surgery is only 44%, and regrowth of residual tumour occurs in over 50% of patients.

Transsphenoidal resection of the adenoma is the main therapeutic approach. Presenting symptoms are related to mass effects and include pituitary insufficiency, headache and visual disturbances. 2 Because of the lack of clinical and biochemical signs of hormonal hypersecretion, NFA can go undetected for a long time and usually are macroadenomas, that is, diameter в‰Ґ1 cm, at the time of diagnosis. 1 Clinically non-functioning adenomas (NFA) account for 15%вЂ“50% of all pituitary adenomas. Pituitary adenomas are benign tumours of the pituitary gland and are recognised as the third most common intracranial neoplasm.

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