Pekic S, Stojanovic M, Popovic V
University of Belgrade, School of Medicine, Belgrade, Serbia -
Minerva Endocrinol. 2015 Dec;40(4):307-19. Epub 2015 Apr 22.
Pituitary adenomas are common benign monoclonal neoplasms accounting for about 15% of intracranial neoplasms. Data from postmortem studies and imaging studies suggest that 1 of 5 individuals in the general population may have pituitary adenoma. Some pituitary adenomas (mainly microadenomas which have a diameter of less than 1 cm) are exceedingly common and are incidentally diagnosed on magnetic resonance imaging (MRI) performed for an unrelated reason (headache, vertigo, head trauma). Most microadenomas remain clinically occult and stable in size, without an increase in tumor cells and without local mass effects. However, some pituitary adenomas grow slowly, enlarge by expansion and become demarcated from normal pituitary (macroadenomas have a diameter greater than 1 cm). They may be clinically silent or secrete anterior pituitary hormones in excess such as prolactin, growth hormone (GH), or adrenocorticotropic hormone (ACTH) causing diseases like prolactinoma, acromegaly, Cushing's disease or rarely thyroid-stimulating hormone (TSH) or gonadotropins (LH, FSH). The incidence of the various subtypes of pituitary adenoma varies but the most common is prolactinoma. Clinically non-functioning pituitary adenomas (NFPAs), which do not secrete hormones often cause local mass symptoms and represent one-third of pituitary adenomas. Given the high prevalence of pituitary adenomas and their heterogeneity (different tumor subtypes), it is critical that clinicians have a thorough understanding of the potential abnormalities in pituitary function and prognostic factors for behavior of pituitary adenomas in order to timely implement specific treatment modalities. Regarding pathogenesis of these tumors genetics, epigenetics and signaling pathways are the focus of current research yet our understanding of pituitary tumorigenesis remains incomplete. Although several genes and signaling pathways have been identified as important factors in the development of pituitary tumors, current treatment modalities fail to completely control the disease and prevent the associated morbidity and mortality. This article reviews the advances in our understanding of pituitary adenoma, the guidance in evaluation and management of different subtypes of pituitary adenomas and the possibility of new therapeutic approaches.
垂体腺瘤是常见的良性单克隆肿瘤，约占颅内肿瘤的15%。尸检研究和影像学研究数据表明，普通人群中每5个人可能就有1人患有垂体腺瘤。一些垂体腺瘤（主要是直径小于1厘米的微腺瘤）极为常见，在因无关原因（头痛、眩晕、头部外伤）进行磁共振成像（MRI）检查时被偶然发现。大多数微腺瘤在临床上隐匿，大小稳定，肿瘤细胞不增加，也无局部占位效应。然而，一些垂体腺瘤生长缓慢，通过膨胀性增大并与正常垂体分界（大腺瘤直径大于1厘米）。它们可能在临床上无症状，或过度分泌垂体前叶激素，如催乳素、生长激素（GH）或促肾上腺皮质激素（ACTH），导致如催乳素瘤、肢端肥大症、库欣病等疾病，或很少见的促甲状腺激素（TSH）或促性腺激素（LH、FSH）分泌过多。垂体腺瘤各亚型的发病率有所不同，但最常见的是催乳素瘤。临床上无功能垂体腺瘤（NFPA）不分泌激素，常引起局部占位症状，占垂体腺瘤的三分之一。鉴于垂体腺瘤的高发病率及其异质性（不同的肿瘤亚型），临床医生全面了解垂体功能的潜在异常以及垂体腺瘤行为的预后因素，以便及时实施特定的治疗方式至关重要。关于这些肿瘤的发病机制，遗传学、表观遗传学和信号通路是当前研究的重点，但我们对垂体肿瘤发生的理解仍不完整。尽管已确定多个基因和信号通路是垂体肿瘤发生发展的重要因素，但目前的治疗方式仍无法完全控制疾病，也无法预防相关的发病率和死亡率。本文综述了我们对垂体腺瘤认识的进展、不同亚型垂体腺瘤评估和管理的指导以及新治疗方法的可能性。
