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Pituitary tumors are the most frequent intracranial tumor and classically considered as benign. However, clinical evidence and recent advances in pathological and molecular analyses suggest that these tumors should be considered as more than a simple endocrine disorder. Descriptions of aggressive pituitary tumors and pituitary carcinomas have increased notably over the last decade following the first report on the successful treatment of pituitary carcinomas using temozolomide. This alkylating agent, widely used to treat glioblastoma, is now the first-line treatment for pituitary tumors resistant to conventional therapies. However, only 40 to 50% of pituitary tumors are sensitive to this treatment. Here, we review results of temozolomide treatment in this indication and discuss the interest of different prognostic markers and perspectives for new therapeutics.Le texte complet de cet article est disponible en PDF.