Guideline Video

Guideline Resources

  • Society:  Congress of Neurological Surgeons (CNS)
  • Publish Date: August 15, 2025
  • Title: Role of Imaging for Patients With Functioning Pituitary Adenomas
  • Title: Role of Surgery for Patients With Functioning Pituitary Adenomas
  • Title: Role of Radiosurgery for Patients With Functioning Pituitary Adenomas
  • Title: Role of Medical Perioperative Management for Patients With Functioning Pituitary Adenomas

Video Transcription

Just published August 15th, 2025 the Congress of Neurological Surgeons' 4 new guidelines on the role of Imaging, Surgery, Radiosurgery, and Medical Perioperative Management for Patients with Functioning Pituitary Adenomas. 

In today’s video we’ll just be going over the summary of recommendations for each guidelines, so for the full guidelines, make sure to check it out on guidelinecentral.com

Starting with the 4 recommendations in the role of IMAGING for patients with functioning Pituitary Adenomas

  • In adult patients with endocrinological suspicion of functioning pituitary adenoma, assessment with MRI is suggested as it provides a more accurate confirmation of the pituitary tumor than endocrine assessment alone. In patients with endocrinologically suspected ectopic adrenocorticotrophic hormone (ACTH) syndrome, CT of the abdomen/pelvis rather than pituitary MRI is suggested. 
  • In adult patients with signs/symptoms and endocrine evaluation suggestive of ACTH-secreting functioning pituitary adenomas with magnetic resonance images negative for tumor, BIPSS is suggested as a diagnostic benefit. 
  • In adult patients with signs/symptoms and endocrine evaluation suggestive of functioning pituitary microadenomas with negative MRIPET using radioactive metabolic tracers is suggested as a diagnostic benefit. 
  • In adult patients with signs/symptoms and endocrine evaluation suggestive of functioning pituitary adenomas, MRI grading systems and/or newer sellar imaging is suggested to further predict postoperative biochemical control and/or complete tumor resection.

Next there are 3 recommendations for the Role of SURGERY for Patients With Functioning Pituitary Adenomas

  • In adult patients with signs/symptoms, endocrine evaluation, and imaging supportive of functioning pituitary microadenomas secreting prolactin, medical management is suggested over surgery for the treatment at primary diagnosis in providing a better clinical outcome.
  • In adult patients with signs/symptoms, endocrine evaluation, and imaging supportive of functioning pituitary microadenomas secreting GH, surgery is suggested over medical management to provide a better clinical outcome and biochemical remission. 
  • In adult patients with signs/symptoms, endocrine evaluation, and imaging supportive of functioning pituitary requiring surgical resection, endoscopic techniques are not superior to microscopic techniques for extent of surgical resection (EOR), hormone remission, length of stay, or complication rates, in the treatment of functional PA. 

On to the 2 recommendations for the Role of RADIOSURGERY for Patients With Functioning Pituitary Adenomas

  • In adult patients with signs/symptoms, endocrine evaluation, and imaging supportive of progressive/recurrent FPAs, it is suggested clinicians use SRS, hypofractionated SRS, FRT, and conventional radiation therapy to provide improved radiographic control with variable rates of hormonal reduction. 
  • In adult patients with signs/symptoms, endocrine evaluation, and imaging indicative of FPA requiring radiosurgery treatment, clinicians may continue to administer endocrine suppressive medical treatment before SRS as this may not affect radiographic control.

And last, the recommendations for the role of Medical Perioperative Management for Patients With Functioning Pituitary Adenomas

  • In adult patients with FPAs who undergo TSS, fluid restriction after surgery is a suggested effective approach to prevent delayed hyponatremia and reduce hospital readmission for hyponatremia. There is not enough evidence to support serum sodium check without fluid restriction as a preventative strategy to reduce hyponatremia. 
  • Preoperative medical treatment with somatostatin analogs for patients with GH-secreting tumors is not routinely suggested, as there is insufficient evidence demonstrating a benefit to long-term biochemical remission, medical comorbidities, or surgical complications. 
  • Postoperative serum cortisol monitoring within the immediate postoperative period is suggested using a cutoff level of <2 micrograms per decileter as a predictor of remission and an indicator for glucocorticoid replacement. 

And there you have it. Make sure to check out the full guidelines from the Congress of Neurological Surgeons and other related clinical decision support tools at guidelinecentral.com.

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