Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France.
Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France; Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, 1090 Vienna, Austria.
Presse Med. 2021 Dec;50(4):104086. doi: 10.1016/j.lpm.2021.104086. Epub 2021 Oct 28.
Clinically non functioning pituitary adenomas (NFPAs) include all pituitary adenomas that are not hormonally active. They are not associated with clinical syndromes such as amenorrhea-galactorrhea (prolactinomas), acromegaly, Cushing's disease or hyperthyroidism (TSH-secreting adenomas) and are therefore usually diagnosed by signs and symptoms related to a mass effect (headache, visual impairment, sometimes pituitary apoplexy), but also incidentally. Biochemical work up often documents several pituitary insufficiencies. In histopathology, the majority of NFPAs are gonadotroph. In the absence of an established medical therapy, surgery is the mainstay of treatment, unless contraindicated or in particular situations (e.g. small incidentalomas, distance from optic pathways). Resection, generally via a trans-sphenoidal approach (with the help of an endoscope), should be performed by a neurosurgeon with extensive experience in pituitary surgery, in order to maximize the chances of complete resection and to minimize complications. If a tumor remnant persists, watchful waiting is preferred to routine radiotherapy, as long as the tumor residue does not grow and is distant from the optic pathways. NFPA can sometimes recur even after complete resection, but predicting the individual risk of tumor remnant progression is difficult. Postoperative irradiation is only considered in case of residual tumor growth or relapse, due to its potential side effects.
临床上无功能垂体腺瘤（NFPAs）包括所有无激素活性的垂体腺瘤。它们与临床综合征无关，如闭经-溢乳（催乳素瘤）、肢端肥大症、库欣病或甲状腺功能亢进（TSH 分泌腺瘤），因此通常通过与肿块效应相关的体征和症状（头痛、视力障碍，有时是垂体卒中）来诊断，但也可能偶然发现。生化检查通常记录了几种垂体功能减退。在组织病理学上，大多数 NFPAs 是促性腺激素腺瘤。在没有既定的医学治疗的情况下，手术是治疗的主要方法，除非存在禁忌症或在特殊情况下（例如，小的偶发瘤、远离视路）。切除，通常通过经蝶窦入路（借助内窥镜）进行，应由具有丰富垂体手术经验的神经外科医生进行，以最大限度地提高完全切除的机会并最小化并发症。如果肿瘤残留存在，只要肿瘤残留没有生长且远离视路，就应优先选择密切观察等待，而不是常规放疗。NFPAs 即使在完全切除后有时也会复发，但预测肿瘤残留进展的个体风险很困难。仅在残留肿瘤生长或复发的情况下才考虑术后放疗，因为其可能有副作用。
