Freda Pamela U, Bruce Jeffrey N, Khandji Alexander G, Jin Zhezhen, Hickman Richard A, Frey Emily, Reyes-Vidal Carlos, Otten Marc, Wardlaw Sharon L, Post Kalmon D
Departments of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York.
Departments of Neurosurgery, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York.
J Endocr Soc. 2020 Feb 18;4(4):bvaa021. doi: 10.1210/jendso/bvaa021. eCollection 2020 Apr 1.
Clinically nonfunctioning pituitary adenomas (CNFPAs) typically remain undetected until mass effect symptoms develop. However, currently, head imaging is performed commonly for many other indications, which may increase incidental discovery of CNFPAs. Since current presentation and outcome data are based on older, retrospective series, a prospective characterization of a contemporary CNFPA cohort was needed.
To determine the prevalence of incidental presentation and hypopituitarism and its predictors in a CNFPA cohort that spanned 6 to 9 mm micro- to macroadenoma included observational and surgical therapy.
At enrollment in a prospective, observational study, 269 patients with CNFPAs were studied by history, examination, blood sampling, and pituitary imaging analysis and categorized into incidental or symptoms presentation groups that were compared.
Presentation was incidental in 48.7% of patients and due to tumor symptoms in 51.3%. In the symptoms and incidental groups, 58.7% and 27.4% of patients had hypopituitarism, respectively, and 25% of patients with microadenomas had hypopituitarism. Many had unappreciated signs and symptoms of pituitary disease. Most tumors were macroadenomas (87%) and were larger in the symptoms than incidental and hypopituitary groups than in the eupituitary groups. The patients in the incidental group were older, and males were older and had larger tumors in both the incidental and symptoms groups.
Patients with CNFPAs commonly present incidentally and with previously unrecognized hypopituitarism and symptoms that could have prompted earlier diagnosis. Our data support screening all large micro and macro-CNFPAs for hypopituitarism. Most patients with CNFPAs still have mass effect signs at presentation, suggesting the need for more awareness of pituitary disease. Our ongoing, prospective observation of this cohort will assess outcomes of these CNFPA groups.
临床上无功能垂体腺瘤（CNFPAs）通常在出现占位效应症状之前未被发现。然而，目前，头部成像常用于许多其他适应症，这可能会增加CNFPAs的偶然发现。由于目前的临床表现和结局数据基于较旧的回顾性系列研究，因此需要对当代CNFPA队列进行前瞻性特征描述。
确定在一个涵盖6至9毫米微腺瘤至大腺瘤的CNFPA队列中偶然发现和垂体功能减退的患病率及其预测因素，该队列包括观察性和手术治疗。
在一项前瞻性观察性研究中，对269例CNFPAs患者进行了病史、检查、血液采样和垂体成像分析，并分为偶然发现或有症状表现组进行比较。
48.7%的患者为偶然发现，51.3%的患者是由于肿瘤症状。在有症状组和偶然发现组中，分别有58.7%和27.4%的患者有垂体功能减退，25%的微腺瘤患者有垂体功能减退。许多患者有未被察觉的垂体疾病体征和症状。大多数肿瘤为大腺瘤（87%），有症状组的肿瘤比偶然发现组和垂体功能减退组的肿瘤大，而垂体功能正常组的肿瘤较小。偶然发现组的患者年龄较大，在偶然发现组和有症状组中，男性年龄较大且肿瘤较大。
CNFPAs患者通常是偶然发现的，并且存在以前未被认识的垂体功能减退和本可促使早期诊断的症状。我们的数据支持对所有大的微腺瘤和大腺瘤性CNFPAs进行垂体功能减退筛查。大多数CNFPAs患者在就诊时仍有占位效应体征，这表明需要提高对垂体疾病的认识。我们对该队列正在进行的前瞻性观察将评估这些CNFPA组的结局。
