AlMalki Mussa H, Ahmad Maswood M, Brema Imad, AlDahmani Khaled M, Pervez Nadeem, Al-Dandan Sadeq, AlObaid Abdullah, Beshyah Salem A
Obesity, Endocrine and Metabolism Centre, King Fahad Medical City, Riyadh, Saudi Arabia.
Faculty of Medicine, King Saud Bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia.
Clin Med Insights Endocrinol Diabetes. 2020 Jun 24;13:1179551420932921. doi: 10.1177/1179551420932921. eCollection 2020.
Non-functioning pituitary adenomas (NFPAs) are benign pituitary tumours that constitute about one-third of all pituitary adenomas. They typically present with symptoms of mass effects resulting in hypopituitarism, visual symptoms, or headache. Most NFPAs are macroadenomas (>1 cm in diameter) at diagnosis that can occasionally grow quite large and invade the cavernous sinus causing acute nerve compression and some patients may develop acute haemorrhage due to pituitary apoplexy. The progression from benign to malignant pituitary tumours is not fully understood; however, genetic and epigenetic abnormalities may be involved. Non-functioning pituitary carcinoma is extremely rare accounting for only 0.1% to 0.5 % of all pituitary tumours and presents with cerebrospinal, meningeal, or distant metastasis along with the absence of features of hormonal hypersecretion. Pituitary surgery through trans-sphenoidal approach has been the treatment of choice for symptomatic NFPAs; however, total resection of large macroadenomas is not always possible. Recurrence of tumours is frequent and occurs in 51.5% during 10 years of follow-up and negatively affects the overall prognosis. Adjuvant radiotherapy can decrease and prevent tumour growth but at the cost of significant side effects. The presence of somatostatin receptor types 2 and 3 (SSTR3 and SSTR2) and D2-specific dopaminergic receptors (D2R) within NFPAs has opened a new perspective of medical treatment for such tumours. The effect of dopamine agonist from pooled results on patients with NFPAs has emerged as a very promising treatment modality as it has resulted in reduction of tumour size in 30% of patients and stabilization of the disease in about 58%. Despite the lack of long-term studies on the mortality, the available limited evidence indicates that patients with NFPA have higher standardized mortality ratios (SMR) than the general population, with women particularly having higher SMR than men. Older age at diagnosis and higher doses of glucocorticoid replacement therapy are the only known predictors for increased mortality.
无功能垂体腺瘤（NFPAs）是良性垂体肿瘤，约占所有垂体腺瘤的三分之一。它们通常表现为占位效应症状，导致垂体功能减退、视觉症状或头痛。大多数NFPAs在诊断时为大腺瘤（直径>1厘米），偶尔会长得很大并侵犯海绵窦，导致急性神经受压，一些患者可能因垂体卒中而发生急性出血。垂体肿瘤从良性向恶性的进展尚未完全了解；然而，可能涉及遗传和表观遗传异常。无功能垂体癌极为罕见，仅占所有垂体肿瘤的0.1%至0.5%，表现为脑脊液、脑膜或远处转移，且无激素分泌过多的特征。经蝶窦入路的垂体手术一直是有症状NFPAs的首选治疗方法；然而，大型大腺瘤并不总是能够完全切除。肿瘤复发很常见，在10年随访期间复发率为51.5%，对总体预后产生负面影响。辅助放疗可以减少并预防肿瘤生长，但会带来明显的副作用。NFPAs中存在2型和3型生长抑素受体（SSTR3和SSTR2）以及D2特异性多巴胺能受体（D2R），为这类肿瘤的药物治疗开辟了新的前景。汇总结果显示，多巴胺激动剂对NFPAs患者的疗效已成为一种非常有前景的治疗方式，因为它使30%的患者肿瘤缩小，约58%的患者病情稳定。尽管缺乏关于死亡率的长期研究，但现有的有限证据表明，NFPA患者的标准化死亡率（SMR）高于一般人群，女性的SMR尤其高于男性。诊断时年龄较大和更高剂量的糖皮质激素替代治疗是已知的仅有的死亡率增加的预测因素。
