Second-line treatment for XXXX when initial pituitary surgery is unsuccessful.

@entity1 @entity699 @entity977 @entity7961 @entity2014
PURPOSE OF REVIEW: Adenectomy via transsphenoidal surgery is considered the treatment of choice for @entity699 . It is successful in about 80% of @entity1 in the hands of an experienced surgeon. When transsphenoidal surgery fails or is contraindicated, a second-line treatment must be chosen. The review focuses on second-line treatment options. RECENT FINDINGS: Repeat pituitary surgery results in the cure of @entity699 in about 50% of cases. Bilateral adrenalectomy results in resolution of hypercortisolemia in almost all @entity1 , but leaves the @entity1 glucocorticoid and mineralocorticoid deficient. @entity2014 , depending on the definition, occurs in up to 35% of these @entity1 . Irradiation of the residual @entity977 typically takes several years before the full effect is realized; it can cause @entity7961 . Finally, pharmacologic treatment of persistent hypercortisolemia can be effective, but is often associated with untoward side effects. These side effects are a powerful deterrent to its use. Several new pharmacologic agents are being studied and show some promise. SUMMARY: Each of the second-line treatments for @entity699 currently available can be effective at treating @entity699 , but each has significant limitations. New pharmacologic agents may soon offer some very exciting treatment options.
