Cury Maria Licia Calado de Aguiar Ribeiro, Fernandes Juliana Coutinho, Machado Hélio Rubens, Elias Lucila Leico, Moreira Ayrton Custódio, Castro Margaret de
Divisão de Endocrinologia e Metabologia, Departamento de Clínica Médica, Universidade de São Paulo.
Arq Bras Endocrinol Metabol. 2009 Feb;53(1):31-9. doi: 10.1590/s0004-27302009000100006.
This study is an updated review of a Southeast Brazilian experience NFPA, emphasizing clinical features, laboratorial and imaging assessment, therapeutic management and outcome.
Retrospective study, in which 104 patients with NFPA were evaluated by the same team of endocrinologists and neurosurgeon. Patients underwent biochemical evaluation, radiological studies and visual field assessment.
Hypopituitarism and neuro-ophthalmological defects were observed in 89%. We observed GH deficiency (81.4%), hypogonadism (63.3%), adrenal hypofunction (59.5%), hypothyroidism (20.4%), high (38.5%) and low (16.7%) prolactin levels. Preoperative imaging classified 93% of the tumors as macroadenomas. Extra-sellar expansion was observed in 83.8%. Varying degrees of visual disturbance were observed in 74%. Primary treatment was transsphenoidal surgery (75%). Clinical control was achieved with one surgery in 37.5 % of patients. The majority of patients needed a second therapeutic approach, radiotherapy or other surgeries. Immunohistochemistry resulted negative for pituitary hormones in 43%. Improvement of neuro-ophthalmological symptoms was observed in 61% of the patients after treatment.
Our data confirm elevated prevalence of mass effect and hypopituitarism in patients harboring NFPA. Recurrence due to invasion or incomplete resection of the tumor is quite common, which frequently leads to a second therapeutic option.
本研究是对巴西东南部非功能性垂体腺瘤（NFPA）经验的更新综述，重点关注临床特征、实验室及影像学评估、治疗管理和预后。
回顾性研究，由同一组内分泌科医生和神经外科医生对104例NFPA患者进行评估。患者接受了生化评估、放射学检查和视野评估。
89%的患者出现垂体功能减退和神经眼科缺陷。我们观察到生长激素缺乏（81.4%）、性腺功能减退（63.3%）、肾上腺功能减退（59.5%）、甲状腺功能减退（20.4%），催乳素水平升高（38.5%）和降低（16.7%）。术前影像学检查将93%的肿瘤分类为大腺瘤。83.8%的患者观察到鞍外扩展。74%的患者观察到不同程度的视觉障碍。主要治疗方法是经蝶窦手术（75%）。37.5%的患者通过一次手术实现了临床控制。大多数患者需要第二种治疗方法，即放疗或其他手术。43%的患者垂体激素免疫组化结果为阴性。治疗后61%的患者神经眼科症状有所改善。
我们的数据证实，NFPA患者中占位效应和垂体功能减退的患病率较高。肿瘤侵袭或不完全切除导致的复发很常见，这常常导致第二种治疗选择。
