Observation without specific treatment is sometimes appropriate for patients with nonfunctioning pituitary tumors, but this decision must be made carefully, and the patient must be closely followed. Observation is most appropriate for smaller tumors that do not threaten vision or cause headaches or other symptoms. Such tumors are often found incidentally when MRIs or CTs are performed for unrelated reasons (12). Most of these tumors grow slowly and can safely be monitored with serial MRIs. In fact, a recent cost-effectiveness analysis suggests that a single PRL level, without repeated MRIs, may be appropriate for incidentally discovered microadenomas (14). Observation may also be appropriate in older patients with large tumors who have other serious medical problems and do not have a long life expectancy, because the slow-growing tumor may not cause any problems in the patient's lifetime. In most cases, however, large tumors should be treated.

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The Prevention and Treatment of Headaches

The Prevention and Treatment of Headaches

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