{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:25:15Z","timestamp":1793157915913,"version":"4.5.0"},"reference-count":318,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010382","name":"European Society of Endocrinology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010382","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pituitary tumours, originating from endocrine cells of the anterior pituitary, are quite common, and in most cases well-controlled by surgery or medical treatment. However, a small subset of pituitary tumours presents with multiple local recurrences or tumour progression despite combined surgical, medical or radiotherapeutic treatment. These are known as aggressive pituitary tumours (APT); also called aggressive pituitary neuroendocrine tumours (PitNETs); or, in the rare case of metastases, pituitary carcinomas (PC) or metastatic PitNETs. Early identification of APT is challenging but is of major clinical importance as they are associated with an increased morbidity and mortality even in the absence of metastases. Here, we provide a revision of the first international, interdisciplinary European Society of Endocrinology (ESE) clinical practice guideline on APTs and PC (2018). Since publication of the 2018 guideline, results from the second ESE survey on APT and PC were published, and more data on APT treatment, including temozolomide, immune checkpoint inhibitors and bevacizumab, emerged. These data are reviewed in this guideline and translated into a practical algorithm to guide APT and PC management. Furthermore, standardized reporting of imaging and histopathological investigations of these tumours is proposed, and the role of molecular analysis is discussed. Last, a section is dedicated to special circumstances such as APT in pregnancy.<\/jats:p>","DOI":"10.1093\/ejendo\/lvaf100","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T07:49:35Z","timestamp":1749714575000},"page":"G1-G34","source":"Crossref","is-referenced-by-count":70,"title":["Revised European Society of Endocrinology Clinical Practice Guideline for the management of aggressive pituitary tumours and pituitary carcinomas"],"prefix":"10.1093","volume":"192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9517-338X","authenticated-orcid":false,"given":"Gerald","family":"Raverot","sequence":"first","affiliation":[{"name":"Endocrinology Department, Reference Centre for Rare Pituitary Diseases HYPO, \u201cGroupement Hospitalier Est\u201d Hospices Civils de Lyon , Bron F-69677 ,","place":["France"]},{"name":"Lyon 1 University, Claude Bernard University , Lyon F-69008 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4844-8336","authenticated-orcid":false,"given":"Pia","family":"Burman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, Lund University , Malm\u00f6 SE-205 02 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5505-0852","authenticated-orcid":false,"given":"Ana Paula","family":"Abreu","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital, Division of Endocrinology, Diabetes and Hypertension\/Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3865-0810","authenticated-orcid":false,"given":"Anthony P","family":"Heaney","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, David Geffen School of Medicine at UCLA , Los Angeles, CA 90064, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2617-5429","authenticated-orcid":false,"given":"Leonie","family":"van Hulsteijn","sequence":"additional","affiliation":[{"name":"European Society of Endocrinology , Bristol, BS34 8YU ,","place":["United Kingdom"]},{"name":"Department of Clinical Epidemiology, Leiden University Medical Center , 2333 ZA Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0659-261X","authenticated-orcid":false,"given":"Andrew L","family":"Lin","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Neurosurgery, Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center , New York, NY 10065 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Marcus","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital for Neurology and Neurosurgery , London WC1N 3BG ,","place":["United Kingdom"]},{"name":"Division of Neurosurgery, UCL Queen Square Institute of Neurology , London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2859-5566","authenticated-orcid":false,"given":"Ann","family":"McCormack","sequence":"additional","affiliation":[{"name":"Garvan Institute of Medical Research , Sydney, NSW 2010 ,","place":["Australia"]},{"name":"Department of Endocrinology, St Vincent's Hospital , Sydney, NSW 2010 ,","place":["Australia"]},{"name":"St Vincent's Clinical School, University of New South Wales , Sydney, NSW 2010 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Minniti","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I , Rome 00161 ,","place":["Italy"]},{"name":"IRCCS Neuromed , Pozzilli IS 86077 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Petersenn","sequence":"additional","affiliation":[{"name":"ENDOC Center for Endocrine Tumors , Hamburg 22587 ,","place":["Germany"]},{"name":"University of Duisburg-Essen , Essen 45141 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Popovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade , Belgrade 11 000 ,","place":["Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7378-4374","authenticated-orcid":false,"given":"Marily","family":"Theodoropoulou","sequence":"additional","affiliation":[{"name":"Department of Medicine IV, LMU University Hospital, LMU Munich , Munich 813777 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Trouillas","sequence":"additional","affiliation":[{"name":"Lyon 1 University, Claude Bernard University , Lyon F-69008 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1333-7580","authenticated-orcid":false,"given":"Olaf M","family":"Dekkers","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Leiden University Medical Center , 2333 ZA Leiden ,","place":["The Netherlands"]},{"name":"Department of Endocrinology and Metabolism, Leiden University Medical Center , Leiden 2333ZG ,","place":["The Netherlands"]},{"name":"Department of Clinical Epidemiology, Aarhus University , Aarhus 8200 ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"issue":"10","key":"2025062612175988300_lvaf100-B1","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1056\/NEJMra1810772","article-title":"Pituitary-tumor endocrinopathies","volume":"382","author":"Melmed","year":"2020","journal-title":"N Engl J Med"},{"issue":"6","key":"2025062612175988300_lvaf100-B2","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1210\/endrev\/bnac010","article-title":"Clinical biology of the pituitary adenoma","volume":"43","author":"Melmed","year":"2022","journal-title":"Endocr Rev"},{"issue":"12","key":"2025062612175988300_lvaf100-B3","doi-asserted-by":"publisher","first-page":"4769","DOI":"10.1210\/jc.2006-1668","article-title":"High prevalence of pituitary adenomas: 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