A review of developments in the management of pituitary disease in the last 30 years revealsthe contrasting pace of advances in treatment options between acromegaly and Cushing's disease. Both diseases have benefited from refinements in surgery and radiotherapy. The opening up of the transsphenoidal route to the fossa, the operating microscope, and more recently the endoscope, have greatly improved the results of surgery which still remains the first line of treatment. Multi-fractional, three field radiotherapy has been available for 40 years, but the accuracy afforded by computed tomography (CT) planning, and more lately superseded by magnetic resonance imaging (MRI), has reduced morbidity, while in the last decade the Gamma Knife and other forms of stereotactic radiotherapy have provided advances.
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