1Department of Internal Medicine.
2Pituitary Center.
J Neurosurg. 2018 Sep 14;131(2):500-506. doi: 10.3171/2018.4.JNS172148. Print 2019 Aug 1.
The natural history and proper algorithm for follow-up testing of nonfunctioning pituitary adenomas (PAs) are not well known, despite their relatively high prevalence. The aim of this study was to suggest the optimal follow-up algorithm for nonfunctioning PAs based on their natural history.
The authors followed up 197 patients with nonfunctioning PAs that had not been treated (including surgery and radiation therapy) at the time of detection, in a single center, between March 2000 and February 2017. They conducted a hormone test, visual field test, and MRI at the time of diagnosis and yearly thereafter.
The overall median follow-up duration was 37 months. Microadenomas (n = 38) did not cause visual disturbance, pituitary apoplexy, or endocrine dysfunction. The incidence of patients with tumor volume growth ≥ 20% was higher for macroadenomas than microadenomas (13.8 vs 5.0 per 100 person-years [PYs], p = 0.002). The median time to any tumor growth was 4.8 years (95% CI 3.4-4.8 years) for microadenomas and 4 years (95% CI 3.3-4.2 years) for macroadenomas. The overall incidence of worsening visual function was 0.69 per 100 PYs. Patients with a tumor volume growth rate ≥ 0.88 cm3/year (n = 20) had a higher incidence of worsening visual function (4.69 vs 0.30 per 100 PYs, p < 0.001). The tumor growth rate of all microadenomas was < 0.88 cm3/year. The median time to tumor growth ≥ 20% was 3.3 years (95% CI 1.8-3.9 years) in patients with a tumor growth rate ≥ 0.88 cm3/year and 4.9 years (95% CI 4.6-7.2 years) in patients with a tumor growth rate < 0.88 cm3/year.
The authors have devised a follow-up strategy based on the tumor volume growth rate as well as initial tumor volume. In patients with microadenomas, the next MRI study can be performed at 3 years. In patients with macroadenomas, the second MRI study should be performed between 6 months and 1 year to assess the tumor growth rate. In patients with a tumor growth rate ≥ 0.88 cm3/year, the MRI study should be performed within 2 years. In patients with a tumor growth rate < 0.88 cm3/year, the MRI study can be delayed until 4 years.
尽管无功能性垂体腺瘤（PAs）的发病率相对较高，但人们对其自然病史和适当的随访检测算法仍知之甚少。本研究旨在根据其自然病史，为无功能性 PAs 提出最佳随访算法。
作者在 2000 年 3 月至 2017 年 2 月期间，在一个中心对 197 例未经治疗（包括手术和放射治疗）的无功能性 PA 患者进行了随访。他们在诊断时以及此后每年进行激素检测、视野检查和 MRI。
总的中位随访时间为 37 个月。微腺瘤（n = 38）不会引起视力障碍、垂体卒中或内分泌功能障碍。与微腺瘤相比，大腺瘤患者肿瘤体积增长≥20%的发生率更高（每 100 人年发生 13.8 例 vs 5.0 例，p = 0.002）。微腺瘤和大腺瘤中任何肿瘤生长的中位时间分别为 4.8 年（95%CI 3.4-4.8 年）和 4 年（95%CI 3.3-4.2 年）。视力功能恶化的总发生率为每 100 人年 0.69 例。肿瘤体积增长率≥0.88cm3/年的患者（n = 20）视力功能恶化的发生率更高（4.69 例 vs 0.30 例，每 100 人年，p < 0.001）。所有微腺瘤的肿瘤生长率均<0.88cm3/年。肿瘤生长率≥0.88cm3/年的患者肿瘤生长≥20%的中位时间为 3.3 年（95%CI 1.8-3.9 年），肿瘤生长率<0.88cm3/年的患者为 4.9 年（95%CI 4.6-7.2 年）。
作者根据肿瘤体积增长率以及初始肿瘤体积制定了随访策略。微腺瘤患者的下一次 MRI 检查可在 3 年后进行。大腺瘤患者应在 6 个月至 1 年内进行第二次 MRI 检查，以评估肿瘤生长率。肿瘤生长率≥0.88cm3/年的患者应在 2 年内进行 MRI 检查。肿瘤生长率<0.88cm3/年的患者，MRI 检查可延迟至 4 年后进行。
