Molitch Mark E
Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Handb Clin Neurol. 2014;124:167-84. doi: 10.1016/B978-0-444-59602-4.00012-5.
Clinically nonfunctioning adenomas range from being completely asymptomatic, and therefore detected either at autopsy or as incidental findings on head MRI or CT scans performed for other reasons, to causing significant hypothalamic/pituitary dysfunction and visual field compromise due to their large size. Patients with incidental adenomas should be screened for hypersecretion (prolactin, insulin-like growth factor 1, midnight salivary cortisol) and for hypopituitarism (macroadenomas). In the absence of hypersecretion, hypopituitarism, or visual field defects, patients may be followed by periodic screening by MRI for enlargement, at which point surgery may be necessary. Symptomatic patients with clinically nonfunctioning adenomas are generally treated by transsphenoidal surgery. Postoperative MRIs are done at 3-4 months after surgery to assess for completeness of resection and then repeated yearly for 3-5 years and subsequently less frequently to assess for regrowth. For those with no visible tumor on MRI, the tumor regrowth rate is about 13% and such patients may be followed with periodic MRIs. For those with visible tumor, the tumor regrowth rate is about 40%. This regrowth rate may be substantially reduced with the use of dopamine agonists and radiotherapy.
临床上无功能腺瘤的表现范围很广，从完全无症状（因此在尸检时发现，或因其他原因进行头部磁共振成像（MRI）或计算机断层扫描（CT）时偶然发现）到因体积巨大导致明显的下丘脑/垂体功能障碍和视野受损。偶然发现腺瘤的患者应筛查激素分泌过多情况（催乳素、胰岛素样生长因子1、午夜唾液皮质醇）和垂体功能减退情况（大腺瘤）。在没有激素分泌过多、垂体功能减退或视野缺损的情况下，患者可通过定期MRI检查监测腺瘤是否增大，必要时可能需要进行手术。有症状的临床上无功能腺瘤患者一般采用经蝶窦手术治疗。术后在3至4个月进行MRI检查以评估切除的完整性，然后在3至5年内每年重复检查，随后检查频率降低以评估肿瘤是否复发。对于MRI上无可见肿瘤的患者，肿瘤复发率约为13%，此类患者可定期进行MRI检查。对于有可见肿瘤的患者，肿瘤复发率约为40%。使用多巴胺激动剂和放疗可能会大幅降低这种复发率。
