Management of Pituitary Tumors: The Clinician’s Practical Guide, 2nd edition.

Pituitary tumors are treated by a variety of medical generalists and specialists. Those most likely to supervise the care of patients with pituitary adenomas (in the United States) are endocrinologists and neurosurgeons. In addition, family practitioners, ophthalmologists, otolaryngologists, gynecologists, and urologists all encounter such patients and should have a basic understanding of the mechanisms and categories of pituitary disease. Designed as a manual for trainees in these specialties, Management of Pituitary Tumors: The Clinician’s Practical Guide, 2nd Edition, offers a relatively comprehensive accumulation of information on the different functional subtypes of pituitary tumor and on the extant modes of treatment. On the whole, the text is quite readable, and the chapters are sufficiently compact and to the point that they can be read quickly and efficiently for guidance on the specific issues they cover. The book has both strengths and weaknesses. The range of chapters is broad, yet there is no chapter on thyrotropin-secreting adenomas, which admittedly are rare but which do complete the roster of functional types covered in other pituitary textbooks. The book starts well, first with a chapter on pathogenesis that covers the basics without being overly detailed, and then a chapter on prolactinomas that gives appropriate weight to the use of the various dopamine agonists, as well as to their interplay with surgical and radiotherapeutic approaches. In the acromegaly section, however, there is little clinical description of this disease and no graphic display of what an acromegalic patient looks like. Given this book’s target audience, such information would be most helpful in future editions. Descriptions of treatment for acromegaly are well done, as is the summary of the complexities of treatment for Cushing’s disease, usually the most daunting of the pituitary endocrinopathies. Here, too, a photograph of the Cushingoid state would be helpful to trainees. The chapter on nonfunctional tumors is largely devoted to describing the endocrine hypofunction that such lesions may cause, but it also gives a balanced discussion of the sticky issue of the role of radiotherapy in treating residual tumor after surgery. The chapters on treatment are an important element in the book’s strengths. Anesthetic and surgical considerations are well described, and appropriate space is given to the newer techniques of endoscopy, computer-assisted intraoperative navigation, and intraoperative MRI. Endoscopic surgery merits a chapter all to itself and gets a concise one that suffices to introduce the technique. Here again, however, the figures are inadequate; the surgeon’s key to a successful endoscopic procedure is understanding what he is seeing from an unfamiliar perspective through an unfamiliar lens, and sharper images of higher quality should be provided. Radiotherapy is described in two separate chapters, one devoted to standard and conformal techniques, and one to the gamma knife. This focus on one machine gives an imprimatur to this particular instrument that is perhaps unintended by the editors, and it might have been better to discuss radiosurgery as a technique that can be performed successfully and safely on pituitary tumors with a variety of stereotactic focussing systems, including the Linac (Albuquerque, NM) and others. However, the chapter’s substance is sound and cannot be faulted. The book concludes with a quite lengthy but useful chapter on nonadenomatous lesions of the parasellar area and an excellent commentary on pituitary tumors from the patient’s perspective, something that those who care for such patients all too often overlook or grow inured to. This concluding chapter is a valuable reminder of the primacy of the patient in this forest of pathological, radiological, and surgical nuances. This book fills a small but definite niche in the library of those in training or those interested in a manageable volume addressing issues relating to pituitary tumors. It is somewhat Eurocentric in its overall tone, but its accumulation of much pituitary wisdom into a small space is well organized, well written, and compact enough not to overwhelm. I recommend this book to anyone wanting to learn more about this fascinating subset of intracranial tumors.