Peptide Receptor Radionuclide Therapy (Prrt) and the Pituitary: Safety and Efficacy

Peptide receptor radionuclide therapy (PRRT) is an emerging and promising targeted treatment for aggressive pituitary neuroendocrine tumours (PitNETs) and pituitary carcinomas refractory to conventional therapies. Its use is supported by the frequent expression of somatostatin receptors (SSTR), predominantly SSTR2, in pituitary tumour cells, enabling selective delivery of β-emitting radionuclides such as 177Lu-DOTATATE and 90Y-DOTATOC, resulting in targeted antitumour and antisecretory effect. This narrative review summarizes current scanty evidence on PRRT efficacy and safety in aggressive pituitary tumours. Successful outcomes were reported in some cases, in terms of tumour growth and/or hormonal reduction, or relief of mass-effect–related symptoms. PRRT related adverse events are mostly mild and transient, predominantly hematologic, with clinically significant renal toxicity uncommon when amino-acid nephroprotection is used. Preserved pituitary function and no clinically significant PRRT-induced hypopituitarism have been reported. Overall, PRRT represents a biologically rational and potentially effective option for selected patients with SSTR-positive aggressive PitNETs after failure of previous therapies.