Department of Chemical Pathology, University of KwaZulu Natal and National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
California North-State University, College of Medicine, Elk Grove, CA 95757, USA.
Clin Chem Lab Med. 2018 Dec 19;57(2):150-164. doi: 10.1515/cclm-2018-0552.
The pituitary gland is responsible for the production and/or secretion of various hormones that play a vital role in regulating endocrine function within the body. Secretory tumors of the anterior pituitary predominantly, pituitary adenomas, collectively account for 10%-25% of central nervous system tumors requiring surgical treatment. The most common secretory tumors are prolactinomas, which can be diagnosed by basal prolactin levels. Acromegaly can be diagnosed by basal insulin growth-like factor 1 levels and the failure of growth hormone (GH) to suppress during an oral glucose tolerance test. Cushing disease can be diagnosed by demonstrating hypercortisolemia evidenced by increased salivary cortisol levels in the evening, increased urine free cortisol excretion and failure of plasma cortisol to suppress following oral dexamethasone given overnight (1.0 mg). We also discuss the diagnosis of the rarer thyroid-stimulating hormone and gonadotrophin secretory tumors. Morbidity is associated with tumor occurrence, clinical sequelae as well as the related medical, surgical and radiological management. This review focuses on the pathogenesis of secretory tumors of the anterior pituitary with emphasis on molecular mechanisms associated with tumorigenesis and the major role of the clinical chemistry laboratory in diagnosis and management of these tumors.
垂体负责产生和/或分泌各种激素，这些激素在调节体内内分泌功能方面起着至关重要的作用。垂体前叶的分泌性肿瘤主要是垂体腺瘤，占需要手术治疗的中枢神经系统肿瘤的 10%-25%。最常见的分泌性肿瘤是催乳素瘤，可以通过基础催乳素水平来诊断。肢端肥大症可以通过基础胰岛素样生长因子 1 水平和口服葡萄糖耐量试验中生长激素 (GH) 抑制失败来诊断。库欣病可以通过夜间唾液皮质醇水平升高、尿游离皮质醇排泄增加以及口服地塞米松过夜后 (1.0 mg) 血浆皮质醇抑制失败来诊断。我们还讨论了促甲状腺激素和促性腺激素分泌性肿瘤的诊断。发病率与肿瘤发生、临床后遗症以及相关的医学、外科和放射学管理有关。本综述重点介绍了垂体前叶分泌性肿瘤的发病机制，强调了与肿瘤发生相关的分子机制以及临床化学实验室在这些肿瘤的诊断和管理中的主要作用。
