R

TRANS-SPHENOID AL REMOVAL

(depending on patient and centre preference)

if elderly patient with no significant symptoms

Large tumours

BROMOCRIPTINE THERAPY

if hormone level remains high (10-50%)

RADIOTHERAPY

(delayed if fertility required)

monitor for developing osteoporosis

Deteriorating vision

TRANS-SPHENOIDAL DECOMPRESSION

GH secreting

tumour

± impaired

ACTH secreting

vision

tumour

Prolactinoma

± impaired

vision

-¡J1 trial of somatostatin r

TRANS-SPHENOIDAL DECOMPRESSION

if fails _I

(depending on patient and centre preference)

TRIAL OF BROMOCRIPTINE

with visual and hormone level monitoring if fails to shrink tumour

'Giant' tumours with multidirectional spread

TRIAL OF BROMOCRIPTINE

(? somatostatin if GH secretion)

Avoid operation (frontal or trans-sphenoidal decompression) unless rapid deterioration of vision

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