Zawada Natalia Bożena, Kunert-Radek Jolanta, Pawlikowski Marek, Pisarek Hanna, Radek Maciej
Department of Clinical Endocrinology, Chair of Endocrinology, Medical University of Lodz, Poland.
Endokrynol Pol. 2016;67(3):292-8. doi: 10.5603/EP.a2016.0043. Epub 2016 Jun 27.
Non-functioning pituitary adenomas (NFPA) are often diagnosed late as invasive macroadenomas. The surgical resection is usually incomplete and about 50% of patients require additional surgery. Recent data suggest that somatostatin analogues (SSA), so important in the pharmacotherapy of acromegaly, can also be effective in the management of NFPA.
We analysed data of patients who had been treated up to 10 years previously with SSA: 40 with acromegaly (23 - primary, 17 - recurrent tumours) and 22 with NFPA (4 - primary, 18 - recurrent tumours). Hormonal profile, dynamics of tumour size change, ophthalmic syndromes, somatostatin receptor (SSTR) scintigraphy, and immunohistochemistry of SSTR subtypes of operated tumours as well as side effects were investigated.
Biochemical cure of acromegaly was achieved in 57.5% of patients, while reduction of tumour size was observed in 37% of patients and it was more frequent in not-operated cases. Regarding NFPA, stabilisation of tumour size was noticed in 68% of patients. Tumour shrinkage was reported in 9% of cases, but in 23% of the study group the adenoma size increased with indication for reoperation.
The efficacy of SSA in NFPA is much lower in comparison to their well-established effects in the treatment of acromegaly. Stabilisation of tumour size, which is observed in the majority of NFPA, is significantly more frequent in comparison to the natural history of untreated NFPA and our previous studies as well. Analysis of SSTR subtypes is an argument in favour of introduction of novel broad-spectrum SSA that may be more effective in the treatment of NFPA. Referring to acromegaly, adenoma size decrease was reported more frequently in primary therapy. Considering recurrent tumours better outcomes were achieved in patients who were pre-treated with SSA before planned surgery. (Endokrynol Pol 2016; 67 (3): 292-298).
无功能垂体腺瘤（NFPA）常被诊断为侵袭性大腺瘤，诊断较晚。手术切除通常不彻底，约50%的患者需要再次手术。近期数据表明，生长抑素类似物（SSA）在肢端肥大症的药物治疗中非常重要，在NFPA的治疗中也可能有效。
我们分析了10年前接受SSA治疗的患者数据：40例肢端肥大症患者（23例为原发性，17例为复发性肿瘤）和22例NFPA患者（4例为原发性，18例为复发性肿瘤）。研究了激素水平、肿瘤大小变化动态、眼部综合征、生长抑素受体（SSTR）闪烁扫描、手术切除肿瘤的SSTR亚型免疫组化以及副作用。
57.5%的肢端肥大症患者实现了生化治愈，37%的患者观察到肿瘤大小缩小，未手术患者中更常见。对于NFPA，68%的患者肿瘤大小稳定。9%的病例报告有肿瘤缩小，但在23%的研究组中腺瘤大小增加，提示需要再次手术。
与SSA在肢端肥大症治疗中已确立的效果相比，其在NFPA中的疗效要低得多。在大多数NFPA中观察到的肿瘤大小稳定，与未经治疗的NFPA自然病程以及我们之前的研究相比，明显更为常见。SSTR亚型分析支持引入新型广谱SSA，其可能在NFPA治疗中更有效。对于肢端肥大症，原发性治疗中报告腺瘤大小缩小更为频繁。考虑复发性肿瘤，计划手术前接受SSA预处理的患者取得了更好的结果。（《波兰内分泌学》2016年；67（3）：292 - 298）
