Sam Amir H, Shah Sachit, Saleh Keenan, Joshi Jay, Roncaroli Federico, Robinson Stephen, Cox Jeremy, Martin Niamh M, Mendoza Nigel, Meeran Karim, Mehta Amrish, Dhillo Waljit S
Imperial College Healthcare NHS Trust, London, UK.
Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
Clin Endocrinol (Oxf). 2015 Dec;83(6):861-5. doi: 10.1111/cen.12860. Epub 2015 Aug 12.
The natural history and the optimum management of patients with nonfunctioning pituitary adenomas (NFPAs) are unclear.
Our objective was to characterize the natural history of patients with NFPAs managed conservatively.
We conducted a retrospective analysis of patients presenting to a tertiary referral centre between 1986 and 2009. Patients with pituitary adenomas and no clinical or biochemical evidence of hormonal hypersecretion were included. Those presenting with apoplexy or a radiological follow-up period of less than 1 year were excluded. The pituitary imaging for all patients was re-examined by two neuroradiologists in consensus.
The outcome measures were change in tumour size and pituitary hormone function.
Sixty-six patients were managed conservatively for a mean follow-up period of 4·3 years (range: 1-14·7). Forty-seven (71%) had a macroadenoma, and nineteen (29%) had a microadenoma. Tumour size decreased or remained stable in 40% of macroadenomas and 47% of microadenomas. The median annual growth rate of enlarging macroadenomas and microadenomas was 1·0 mm/year and 0·4 mm/year, respectively. The median annual growth rate of macroadenomas was significantly higher than that of microadenomas (P < 0·01). Sixty-eight percentage of patients with a macroadenoma had pituitary hormone deficiency in one or more axes, compared to 42% of those with a microadenoma.
Patients with NFPAs without optic chiasm compression can be managed conservatively. All patients need pituitary function assessment, irrespective of tumour size. These findings provide clinically relevant data for the management of patients with NFPAs.
无功能垂体腺瘤（NFPAs）患者的自然病史和最佳治疗方案尚不清楚。
我们的目的是描述保守治疗的NFPAs患者的自然病史。
我们对1986年至2009年间在一家三级转诊中心就诊的患者进行了回顾性分析。纳入垂体腺瘤患者，且无激素分泌过多的临床或生化证据。排除出现卒中或放射学随访期少于1年的患者。由两名神经放射科医生共同重新检查所有患者的垂体影像学资料。
观察指标为肿瘤大小和垂体激素功能的变化。
66例患者接受保守治疗，平均随访4.3年（范围：1 - 14.7年）。47例（71%）为大腺瘤，19例（29%）为微腺瘤。40%的大腺瘤和47%的微腺瘤肿瘤大小减小或保持稳定。增大的大腺瘤和微腺瘤的年中位生长率分别为1.0毫米/年和0.4毫米/年。大腺瘤的年中位生长率显著高于微腺瘤（P < 0.01）。68%的大腺瘤患者存在一个或多个轴的垂体激素缺乏，而微腺瘤患者为42%。
无视交叉压迫的NFPAs患者可进行保守治疗。所有患者均需进行垂体功能评估，无论肿瘤大小如何。这些发现为NFPAs患者的治疗提供了临床相关数据。
