Pickett Cheryl A
Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195-6426, USA.
Curr Neurol Neurosci Rep. 2005 May;5(3):178-85. doi: 10.1007/s11910-005-0045-9.
The medical treatment of pituitary adenomas has changed significantly over the past decade. Pharmacologic therapy for prolactinomas in the form of dopamine agonists has been available since the 1970s, and somatostatin analogues for treatment of growth hormone (GH)-secreting adenomas were introduced in the 1980s. However, the recent introduction of long-acting forms of these agents has markedly improved efficacy. Furthermore, long-acting somatostatin analogues also have utility in treating thyrotropin adenomas and a subset of adrenocorticotroph tumors. Limited clinical studies with long-acting dopamine agonists suggest that a subset of patients with GH, adrenocorticotroph, and gonadotropin/nonsecreting adenomas may also benefit from therapy with these agents. The introduction of a GH receptor antagonist in the 1990s has added to the pharmacologic armamentarium for treatment of acromegaly. In parallel with improved medical therapy, hormonal assays for assessing tumor activity have improved in sensitivity, necessitating new standards for treatment optimization. This article highlights some of these evolving new ideas and approaches to the pharmacologic management of pituitary adenomas.
在过去十年中，垂体腺瘤的医学治疗发生了显著变化。自20世纪70年代以来，就有以多巴胺激动剂形式存在的泌乳素瘤药物治疗方法，而用于治疗生长激素（GH）分泌型腺瘤的生长抑素类似物在20世纪80年代被引入。然而，这些药物长效剂型的近期问世显著提高了疗效。此外，长效生长抑素类似物在治疗促甲状腺素腺瘤和一部分促肾上腺皮质激素肿瘤方面也有应用价值。对长效多巴胺激动剂的有限临床研究表明，一部分患有GH、促肾上腺皮质激素和促性腺激素/无分泌型腺瘤的患者也可能从这些药物的治疗中获益。20世纪90年代生长激素受体拮抗剂的引入，为肢端肥大症的治疗增添了药物手段。与改进的药物治疗并行的是，用于评估肿瘤活性的激素检测在灵敏度方面有所提高，这就需要新的治疗优化标准。本文重点介绍了垂体腺瘤药物治疗方面一些不断发展的新观念和新方法。
