Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
Neurosurgery. 2011 Aug;69(2):284-93. doi: 10.1227/NEU.0b013e31821bc44e.
Nonfunctioning pituitary adenomas recur after microsurgery. Gamma Knife radiosurgery (GKRS) has been used to treat recurrent adenomas.
To evaluate the long-term rates of tumor control and development of hypopituitarism in patients with nonfunctioning pituitary adenomas after GKRS.
Forty-eight patients with a nonfunctioning pituitary adenoma treated between 1991 and 2004 at the University of Virginia were studied. All patients had more than 4 years of clinical and imaging follow-up.
All patients underwent follow-up imaging and endocrine evaluations, with a duration ranging from 50 to 215 months (median, 80.5 months) and 57 to 201 months (median, 95 months), respectively. New hormone deficiency after GKRS occurred in 19 of 48 patients (39%). Corticotropin/cortisol deficiency developed in 8% of patients, thyroid hormone deficiency in 20.8%, gonadotropin deficiency in 4.2%, growth hormone/insulin-like growth factor 1 in 16.7%, and diabetes insipidus in 2%. Panhypopituitarism including diabetes insipidus developed in 1 patient. Overall, control of tumor volume was 83%. Tumor volume decreased in 36 patients (75%), increased in 8 patients (17%), and was unchanged in 4 patients (8%). Tumor volumes greater than 5 mL at the time of GKRS were associated with a significantly greater rate of growth (P = .003) compared with an adenoma with a volume of 5 mL or less.
GKRS resulted in a high and durable rate of tumor control in patients with a nonfunctioning pituitary adenoma. A higher preoperative tumor volume was associated with an increased rate of tumor growth.
垂体无功能腺瘤经显微手术后会复发。伽玛刀放射外科（GKRS）已被用于治疗复发性腺瘤。
评估 GKRS 治疗垂体无功能腺瘤患者后肿瘤控制和垂体功能减退的长期发生率。
研究了 1991 年至 2004 年期间在弗吉尼亚大学接受治疗的 48 例垂体无功能腺瘤患者。所有患者均有超过 4 年的临床和影像学随访。
所有患者均进行了随访影像学和内分泌评估，随访时间范围为 50 至 215 个月（中位数，80.5 个月）和 57 至 201 个月（中位数，95 个月）。GKRS 后新发激素缺乏发生于 48 例患者中的 19 例（39%）。皮质醇缺乏症在 8%的患者中发生，甲状腺激素缺乏症在 20.8%的患者中发生，促性腺激素缺乏症在 4.2%的患者中发生，生长激素/胰岛素样生长因子 1 在 16.7%的患者中发生，2%的患者发生尿崩症。1 例患者出现全垂体功能减退症伴尿崩症。总体而言，肿瘤体积控制率为 83%。36 例患者（75%）肿瘤体积缩小，8 例患者（17%）肿瘤体积增大，4 例患者（8%）肿瘤体积无变化。GKRS 时肿瘤体积大于 5 mL 的患者，其肿瘤生长速度明显快于肿瘤体积小于或等于 5 mL 的患者（P =.003）。
GKRS 可使垂体无功能腺瘤患者获得较高且持久的肿瘤控制率。术前肿瘤体积较大与肿瘤生长速度加快有关。
