Al-Dahmani Khaled, Mohammad Syed, Imran Fatima, Theriault Chris, Doucette Steve, Zwicker Deborah, Yip Churn-Ern, Clarke David B, Imran Syed Ali
1Department of Medicine,Tawam Hospital in affiliation with Johns Hopkins,Al Ain,United Arab Emirates.
2Dalhousie University,Halifax,Nova Scotia,Canada.
Can J Neurol Sci. 2016 Mar;43(2):291-7. doi: 10.1017/cjn.2015.301. Epub 2015 Nov 2.
Sellar masses (SM) are mostly benign growths of pituitary or nonpituitary origin that are increasingly encountered in clinical practice. To date, no comprehensive population-based study has reported the epidemiology of SM from North America.
To determine the epidemiology of SM in the province of Nova Scotia, Canada.
Data from all pituitary-related referrals within the province were prospectively collected in interlinked computerized registries starting in November 2005. We conducted a retrospective analysis on all patients with SM seen within the province between November 2005 and December 2013.
A total of 1107 patients were identified, of which 1005 were alive and residing within the province. The mean age at presentation was 44.6±18 years, with an overall female preponderance (62%) and a population prevalence rate of 0.1%. Of patients with SM, 837 (83%) had pituitary adenomas and 168 (17%) had nonpituitary lesions. The relative prevalence and standardized incidence ratio, respectively, of various SM were: nonfunctioning adenomas (38.4%; 2.34), prolactinomas (34.3%; 2.22), Rathke's cyst (6.5%; 0.5), growth hormone-secreting adenomas (6.5%; 0.3), craniopharyngiomas (4.5%; 0.2), adrenocorticotropic hormone-secreting adenomas (3.8%; 0.2), meningiomas (1.9%), and others (3.9%; 0.21). At presentation, 526 (52.3%) had masses ≥1 cm, 318 (31.6%) at <1 cm, and 11 (1.1%) had functioning pituitary adenomas without discernible tumor, whereas tumor size data were unavailable in 150 (14.9%) patients. The specific pathologies and their most common presenting features were: nonfunctioning adenoma (incidental, headaches, and vision loss), prolactinomas (galactorrhea, menstrual irregularity, and headache), growth hormone-secreting adenomas (enlarging extremities and sweating), adrenocorticotropic hormone-secreting adenoma (easy bruising, muscle wasting, and weight gain) and nonpituitary lesions (incidental, headaches, and vision problems). Secondary hormonal deficiencies were common, ranging from 19.6% to 65.7%; secondary hypogonadism, hypothyroidism, and growth hormone deficiencies constituted the majority of these abnormalities.
This is the largest North American study to date to assess the epidemiology of SM in a large stable population. Given their significant prevalence in the general population, more studies are needed to evaluate the natural history of these masses and to help allocate appropriate resources for their management.
鞍区肿物（SM）大多是起源于垂体或非垂体的良性肿瘤，在临床实践中越来越常见。迄今为止，尚无基于北美人群的综合性研究报告SM的流行病学情况。
确定加拿大新斯科舍省SM的流行病学情况。
自2005年11月起，前瞻性地收集该省内所有与垂体相关转诊病例的数据，并录入相互关联的计算机化登记系统。我们对2005年11月至2013年12月期间该省内确诊的所有SM患者进行了回顾性分析。
共识别出1107例患者，其中1005例存活且居住在该省内。患者就诊时的平均年龄为44.6±18岁，女性总体占优势（62%），人群患病率为0.1%。在SM患者中，837例（83%）患有垂体腺瘤，168例（17%）患有非垂体病变。各种SM的相对患病率和标准化发病率分别为：无功能腺瘤（38.4%；2.34）、泌乳素瘤（34.3%；2.22）、拉克氏囊肿（6.5%；0.5）、生长激素分泌型腺瘤（6.5%；0.3）、颅咽管瘤（4.5%；0.2）、促肾上腺皮质激素分泌型腺瘤（3.8%；0.2）、脑膜瘤（1.9%）以及其他（3.9%；0.21）。就诊时，526例（52.3%）肿物≥1 cm，318例（31.6%）<1 cm，11例（1.1%）患有有功能的垂体腺瘤但无明显肿瘤，而150例（14.9%）患者的肿瘤大小数据缺失。具体病理类型及其最常见的临床表现为：无功能腺瘤（偶然发现、头痛和视力丧失）、泌乳素瘤（溢乳、月经不规律和头痛）、生长激素分泌型腺瘤（肢端肥大和多汗）、促肾上腺皮质激素分泌型腺瘤（易瘀斑、肌肉萎缩和体重增加）以及非垂体病变（偶然发现、头痛和视力问题）。继发性激素缺乏很常见，范围从19.6%至65.7%；继发性性腺功能减退、甲状腺功能减退和生长激素缺乏占这些异常情况的大多数。
这是迄今为止北美规模最大的一项研究，旨在评估一个大型稳定人群中SM的流行病学情况。鉴于其在普通人群中的显著患病率，需要更多研究来评估这些肿物的自然病程，并为其管理分配适当资源。
