Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany.
Medicover Oldenburg MVZ, Oldenburg, Germany.
Exp Clin Endocrinol Diabetes. 2021 Mar;129(3):250-264. doi: 10.1055/a-1373-4087. Epub 2021 Mar 9.
Although non-functioning pituitary tumors are frequent, diagnostic and therapeutic concepts are not well standardized. We here present the first German multidisciplinary guideline on this topic. The single most important message is to manage the patients by a multidisciplinary team (consisting at least of an endocrinologist, a neurosurgeon, and a (neuro-) radiologist). The initial diagnostic work-up comprises a detailed characterization of both biochemical (focusing on hormonal excess or deficiency states) and morphological aspects (with magnetic resonance imaging of the sellar region). An ophthalmological examination is only needed in presence of symptoms or large tumors affecting the visual system. Asymptomatic, hormonally inactive tumors allow for a 'wait and scan' strategy. In contrast, surgical treatment by an experienced pituitary surgeon is standard of care in case of (impending) visual impairment. Therapeutic options for incompletely resected or recurrent tumors include re-operation, radiotherapy, and observation; the individual treatment plan should be developed multidisciplinary. Irrespective of the therapeutic approach applied, patients require long-term follow-up. Patient with larger pituitary tumors or former surgery/radiotherapy should be regularly counseled regarding potential symptoms of hormonal deficiency states.
虽然无功能垂体瘤很常见，但是其诊断和治疗的概念尚未得到很好的标准化。我们在此呈现了首份关于该主题的德国多学科指南。最重要的信息是由多学科团队（至少包括内分泌学家、神经外科医生和（神经）放射科医生）来管理患者。初始诊断工作包括对生化特征（侧重于激素过多或不足状态）和形态特征（鞍区磁共振成像）进行详细描述。只有在存在症状或影响视觉系统的大肿瘤的情况下，才需要进行眼科检查。无症状、无激素活性的肿瘤可以采取“等待和扫描”的策略。相比之下，如果出现（即将出现）视力障碍，由经验丰富的垂体外科医生进行手术治疗是标准的治疗方法。对于未完全切除或复发的肿瘤的治疗选择包括再次手术、放疗和观察；应多学科制定个体化的治疗计划。无论应用何种治疗方法，患者都需要长期随访。对于有较大垂体瘤或曾接受手术/放疗的患者，应定期告知其潜在的激素缺乏状态的症状。
