Varlamov Elena V, McCartney Shirley, Fleseriu Maria
Oregon Health & Science University, Oregon, USA.
Eur Endocrinol. 2019 Apr;15(1):30-40. doi: 10.17925/EE.2019.15.1.30. Epub 2019 Apr 12.
Pituitary adenomas are benign tumours comprising approximately 16% of all primary cranial neoplasms. Functioning pituitary adenomas (prolactinomas, somatotroph, corticotroph, thyrotroph and rarely gonadotroph adenomas) cause complex clinical syndromes and require prompt treatment to reduce associated morbidity and mortality. Treatment approaches include transsphenoidal surgery, medical therapy and radiation. Medical therapy is the primary therapy for prolactinomas, and surgery by a skilled neurosurgeon is the first-line approach for other functioning pituitary adenomas. A multimodal treatment is frequently necessary to achieve biochemical and clinical control, especially, when surgery is not curative or when medical therapy fails. Several emerging, novel, medical treatments for acromegaly, Cushing's disease and prolactinomas are in phase II and III clinical trials and may become effective additions to the current drug armamentarium. The availability of various management options will allow an individualised treatment approach based on the unique tumour type, clinical situation and patient preference.
垂体腺瘤是良性肿瘤，约占所有原发性颅脑肿瘤的16%。功能性垂体腺瘤（泌乳素瘤、生长激素瘤、促肾上腺皮质激素瘤、促甲状腺激素瘤以及罕见的促性腺激素瘤）会引发复杂的临床综合征，需要及时治疗以降低相关的发病率和死亡率。治疗方法包括经蝶窦手术、药物治疗和放射治疗。药物治疗是泌乳素瘤的主要治疗方法，而由经验丰富的神经外科医生进行的手术则是其他功能性垂体腺瘤的一线治疗方法。为实现生化和临床控制，通常需要采取多模式治疗，尤其是在手术无法治愈或药物治疗失败的情况下。几种针对肢端肥大症、库欣病和泌乳素瘤的新兴、新型药物治疗正处于II期和III期临床试验阶段，可能会成为当前药物库中的有效补充。多种治疗选择的可用性将使基于独特肿瘤类型、临床情况和患者偏好的个体化治疗方法成为可能。
