This consensus outlines the key information regarding the course of the disease and treatment approaches for patients with pituitary adenomas. A multidisciplinary team of specialists, including a neurosurgeon, an endocrinologist, and a radiotherapist, carries out the management of this patient group. The document details the current understanding of the course of the disease and treatment methods for somatotroph, corticotroph, prolactin-secreting, thyrotroph, and clinically non-functioning pituitary adenomas. The applied treatment modalities include surgical, medical, and radiotherapeutic approaches.

The choice of strategy depends on hormonal activity, tumor size, direction of growth, the severity of mass effect, and the presence of somatoneurological complications. Patients should be followed by specialists with the appropriate expertise to diagnose and manage the full spectrum of pituitary adenomas. Upon diagnosis of a pituitary adenoma, consultation with a neurosurgeon, radiologist, and radiotherapist is recommended to exclude meningiomas, craniopharyngiomas, and other neoplasms of the sellar region.

For all patients with acromegaly who are candidates for neurosurgical treatment, surgery is recommended to be performed at medical centers specializing in pituitary disorders. In the vast majority of cases, medical therapy for acromegaly is recommended as second-line therapy. Radiotherapy constitutes the third line of treatment for acromegaly.

The treatment of Cushing’s disease involves surgical, medical, and radiotherapeutic interventions. First-line treatment consists of endoscopic transnasal adenomectomy performed at an expert-level center. In cases where surgery is ineffective, repeat surgery may be considered. Medical therapy or radiotherapy are used as second-line options. In life-threatening hypercortisolism, bilateral adrenalectomy is performed.

The management of prolactin-secreting adenomas involves three main methods: medical, surgical, and radiotherapeutic. Medical therapy is the preferred treatment modality. Surgery is not the treatment of choice for prolactinomas. Adenomectomy is recommended for patients with intolerance or resistance to conservative therapy, or when absolute indications are present.

Upon confirmation of a thyrotropinoma diagnosis, endoscopic transnasal adenomectomy is performed in a specialized medical facility. If surgery is not feasible or for preoperative preparation, somatostatin analogs are used. Thyrostatic agents are not indicated.

For clinically non-functioning pituitary adenomas, surgical treatment is indicated in the presence of: visual field deficits and decreased visual acuity caused by compression of the optic chiasm and optic tracts; oculomotor disturbances such as ophthalmoplegia, diplopia, or other neurological disorders resulting from pathological compression of adjacent neural structures; pituitary apoplexy with visual disturbances; impaired cerebrospinal fluid outflow, hydrocephalus, and intracranial hypertension caused by tumor extension into the third ventricle; CSF rhinorrhea resulting from tumor-induced destruction of the diaphragm and the floor of the sella turcica.